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Questions 149

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Question 1 of 5

During morning assessments, the nurse finds that a client's nephrostomy tube has been clamped. The nurse's first action should be to:

Correct Answer: C

Rationale: Unclamping the nephrostomy tube is the priority to restore urine flow and prevent obstruction or infection.

Question 2 of 5

The school nurse recognizes that meningitis can be caused by which of the following? Select all that apply.

Correct Answer: A,B,C,D,E

Rationale: Meningitis can be caused by bacteria, viruses, fungi, parasites, or noninfectious factors (e.g., cancer, trauma).

Question 3 of 5

The nurse is observing a graduate nurse as she assesses the central venous pressure. Which observation would indicate that the graduate needs further teaching?

Correct Answer: C

Rationale: The Valsalva maneuver falsely elevates CVP; normal breathing is required.

Question 4 of 5

The nurse working in an outpatient clinic has the opportunity to teach a client recently diagnosed with irritable bowel syndrome (IBS). Which of the following topics would be most appropriate for the nurse to include? Select all that apply.

Correct Answer: B, D

Rationale: Stress reduction techniques and daily probiotics can help manage IBS symptoms, while limiting fluids is not recommended, and iced tea may exacerbate symptoms due to caffeine.

Question 5 of 5

The nurse recognizes all of the following as common physical characteristics of a child with Down syndrome EXCEPT

Correct Answer: D

Rationale: Down syndrome features include small, low-set ears, downward slanting eyes, and hyperflexibility. An enlarged tongue (macroglossia) is less common or not a hallmark feature.

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