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Questions 164

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Question 1 of 5

An adult who has a tracheostomy needs to be suctioned. How should the nurse position the client for this procedure?

Correct Answer: B

Rationale: Semi-sitting facilitates airway access and reduces aspiration risk during tracheostomy suctioning. Supine or lateral positions are less effective.

Question 2 of 5

A woman who is at 39 weeks gestation enters the hospital in early labor. Several hours later, she says, 'What's happening? I suddenly feel as though I have to have a bowel movement.' The woman starts bearing down as if to push out stool. What is the best initial action for the licensed practical nurse at this time?

Correct Answer: B

Rationale: The urge to have a bowel movement and bearing down indicate advanced labor or delivery. Panting prevents pushing, allowing time to assess and prepare for delivery.

Question 3 of 5

The nurse is caring for a client with a seizure disorder. Which of the following seizure precautions should the nurse implement? Select all that apply.

Correct Answer: A,C,E

Rationale: Padded rails prevent injury. Suction clears airways. Oxygen supports breathing. Removing linen is unnecessary, and restraints are a last resort due to injury risk.

Question 4 of 5

The home health nurse is reviewing current medications with a client who has hypertension. Which of the following statements by the client would require follow-up?

Correct Answer: B

Rationale: Ibuprofen can reduce the efficacy of antihypertensives and cause fluid retention, worsening hypertension. Omeprazole , docusate , and hydrochlorothiazide are unlikely to interfere with hypertension management.

Question 5 of 5

The nurse is discussing hypertension with a group of people. Which person is at greatest risk for hypertension?

Correct Answer: A

Rationale: Age, obesity, smoking, and family history of hypertension confer the highest risk, as seen in the 63-year-old Caucasian female.

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