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Questions 160

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Extract:


Question 1 of 5

Before suctioning a client with a tracheostomy, which nursing action should the nurse perform first?

Correct Answer: C

Rationale: Administering 100% oxygen (hyperoxygenation) for 1-2 minutes before suctioning helps prevent hypoxia during the procedure, which can cause desaturation.

Question 2 of 5

The nurse is preparing to perform a sterile dressing change. Which action maintains the sterile field?

Correct Answer: A

Rationale: Opening the sterile kit away from the body prevents contamination of the sterile field.

Question 3 of 5

When monitoring the treatment response of a client with diabetes insipidus, which component of the urinalysis is most important for the nurse to assess?

Correct Answer: C

Rationale: Diabetes insipidus causes dilute urine with low specific gravity. Monitoring specific gravity assesses treatment effectiveness in restoring normal urine concentration.

Question 4 of 5

When developing the care plan of a client who has a nasogastric (NG) tube for gastric decompression, which nursing order should be modified because it is considered unsafe?

Correct Answer: A

Rationale: Liberal fluid intake is unsafe for a client with an NG tube for decompression, as it may increase gastric contents and risk aspiration.

Question 5 of 5

The nurse is assessing a client with a history of seizures. Which observation indicates the client is experiencing an aura?

Correct Answer: A

Rationale: An aura is a sensory warning, such as a strange smell, that precedes a seizure.

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