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Questions 163

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Question 1 of 5

An adult comes to the clinic with complaints of frequency and burning on urination. The nurse expects that what test will be ordered for the client?

Correct Answer: A

Rationale: Frequency and burning suggest urinary tract infection; a clean catch urine culture identifies the causative organism and antibiotic sensitivity. CBC, cystoscopy, or straining are less immediate.

Question 2 of 5

The nurse is repairing new prescriptions from the health care provider. Which prescription would require further clarification?

Correct Answer: C

Rationale: Cyclobenzaprine is contraindicated in hepatic impairment due to hepatitis, as it is metabolized by the liver, requiring clarification. Other prescriptions (A, B,
D) are appropriate for the conditions.

Question 3 of 5

The nurse prepares equipment for insertion of a large bore nasogastric (NG) tube for a hospitalized client. Which actions should the nurse take to measure and mark the tube? Select all that apply.

Correct Answer: C,D

Rationale:
To measure an NG tube, measure from nose to earlobe to xiphoid process for approximate insertion depth and mark with tape . Folding in half is inaccurate, measuring to stomach is vague, and rubber clamps are not standard.

Question 4 of 5

In response to a call for assistance by a client in labor, the nurse notes that a loop of the umbilical cord protrudes from the vagina. What is the priority nursing action?

Correct Answer: C

Rationale: Immediate action is needed to relieve pressure on the cord, which puts the fetus at risk due to hypoxia. The knee-chest position accomplishes this. The exposed cord is covered with saline-soaked gauze, not reinserted.

Question 5 of 5

The nurse is caring for a client who had a transurethral resection of the prostate 12 hours ago and is receiving continuous bladder irrigation. The client reports lower abdominal pain rated as an 8 on a scale of 0 to 10. Which of the following actions would be a priority for the nurse to take?

Correct Answer: D

Rationale: Severe abdominal pain post-TURP with bladder irrigation suggests possible catheter obstruction or clot formation. Verifying urine output and characteristics is the priority to ensure patency. Morphine , checking bowel movement , or oxybutynin are secondary.

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