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Questions 164

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Question 1 of 5

An 18 month-old has been brought to the emergency room with irritability, lethargy over 2 days, dry skin, and increased pulse. Based upon the evaluation of these initial findings, the nurse would assess the child for additional findings of

Correct Answer: B

Rationale: Dehydration. These symptoms are consistent with dehydration, requiring further assessment for fluid status.

Question 2 of 5

A transfusion is ordered for a hospitalized client. The charge nurse asks the LPN to start the transfusion. What should the LPN do?

Correct Answer: C

Rationale: LPNs typically cannot initiate blood transfusions due to scope of practice limitations, as it requires specialized monitoring, so the LPN should inform the RN.

Question 3 of 5

The nurse enters the room of a woman who had a vaginal hysterectomy three days ago and finds her crying. What is the best initial approach for the nurse?

Correct Answer: A

Rationale: Asking about her concerns opens therapeutic communication, addressing her emotional needs directly and empathetically.

Question 4 of 5

Which nursing action is essential in the care of an adult following a left side cardiac catheterization?

Correct Answer: D

Rationale: Checking the insertion site for bleeding is critical post-catheterization to detect hematoma or hemorrhage, ensuring patient safety.

Question 5 of 5

The nurse is talking with a client with obsessive-compulsive personality disorder who is scheduled for a colonoscopy. Due to a computer malfunction, the procedure is being postponed by 2 hours. Which of the following responses by the client would be consistent with obsessive-compulsive personality disorder?

Correct Answer: D

Rationale: Obsessive-compulsive personality disorder involves rigidity and need for control, so resistance to schedule changes is typical. The other responses reflect anger, paranoia, or flexibility, less characteristic of the disorder.

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