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Questions 149

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Question 1 of 5

An elderly client is returned to her room after an open reduction and internal fixation of the left femoral head after a fracture. It is MOST important for the nursing care plan to include that the client

Correct Answer: D

Rationale: prevents respiratory complications due to immobility following surgery

Question 2 of 5

The client with preeclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates the understanding of magnesium toxicity?

Correct Answer: C

Rationale: Inserting a Foley catheter allows monitoring of urinary output, which is critical to detect magnesium toxicity, as decreased output is a sign of toxicity.

Question 3 of 5

The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching?

Correct Answer: A

Rationale: Limiting fluid intake to 500 mL per day is incorrect, as adequate hydration is essential in polycythemia vera to reduce blood viscosity and prevent thrombosis.

Question 4 of 5

The nurse is caring for a 12-year-old client with appendicitis. The client's mother is a Jehovah's Witness and refuses to sign the blood permit. What nursing action is most appropriate?

Correct Answer: D

Rationale: Notifying the physician respects the mother's beliefs while ensuring the medical team addresses the refusal appropriately.

Question 5 of 5

The nurse is caring for a client following the reimplantation of the thumb and index finger. Which finding should be reported to the physician immediately?

Correct Answer: B

Rationale: Coolness and discoloration of reimplanted digits indicate compromised blood flow, requiring immediate reporting to prevent tissue loss.

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