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Questions 158

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Question 1 of 5

As the nurse assesses a male adolescent with chlamydia, the nurse determines that a sign of chlamydia is:

Correct Answer: C

Rationale: An enlarged penis is not a sign of chlamydia. Secondary lymphadenitis is a complication of lymphogranuloma venereum. Untreated chlamydial infection can spread from the urethra, causing epididymitis, which presents as a tender, scrotal swelling. Hepatomegaly is not a complication.

Question 2 of 5

A student nurse is observing a neurological nurse perform an assessment. When the nurse asks the client to "stick out his tongue," the nurse is assessing the function of which cranial nerve?

Correct Answer: D

Rationale: The hypoglossal nerve (XII) controls tongue movement. Sticking out the tongue assesses its function. Optic (II) affects vision, olfactory (I) affects smell, and vagus (X) affects visceral functions.

Question 3 of 5

A client tells the nurse that she has a history of urinary tract infections. The nurse would do further health teaching if she verbalizes she will:

Correct Answer: D

Rationale: Restricting fluid intake promotes urinary stasis, increasing infection risk. The other options are appropriate preventive measures.

Question 4 of 5

The client with a cervical dilation of 8cm suddenly becomes short of breath,cyanotic and hypotensive. The nurse should suspect which of the following complications?

Correct Answer: A

Rationale: Amniotic fluid embolus is a rare but life-threatening complication characterized by sudden dyspnea cyanosis and hypotension due to amniotic fluid entering the maternal circulation. These symptoms are not typical of transition phase abruption or cord prolapse.

Question 5 of 5

The client will be more comfortable and the results more accurate when the nurse prepares the client for Leopold's maneuvers by having her:

Correct Answer: A

Rationale: A full bladder would cause discomfort and possible urinary incontinence during the exam. The left side-lying position would not accommodate the exam. The head of the exam table or bed can be slightly elevated to prevent supine hypotension. Arms extended over the head would cause the abdomen to be tighter and less easily palpable. Forcing fluids would encourage a full bladder, which is not desired for the exam.

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