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Questions 158

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Question 1 of 5

The best indicator of peripheral edema is determined by:

Correct Answer: D

Rationale: Checking for pitting (indentation after pressing the skin) is the most direct and reliable indicator of peripheral edema. While weight extremity measurement and intake/output are relevant pitting specifically confirms edema.

Question 2 of 5

A client with a history of asthma is experiencing an acute exacerbation. Which medication would the nurse expect to administer first?

Correct Answer: A

Rationale: Albuterol, a short-acting beta-agonist, is the first-line treatment for acute asthma exacerbation, rapidly relieving bronchospasm. Prednisone (
B), Ipratropium (
C), and Montelukast (
D) are adjunctive or long-term therapies.

Question 3 of 5

When performing Leopold maneuvers on a client at 32 weeks gestation, the nurse would expect to find:

Correct Answer: D

Rationale: At 32 weeks gestation, the fetus is active, and Leopold maneuvers typically detect strong, active fetal movement as the fetus grows and develops.

Question 4 of 5

At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?

Correct Answer: B

Rationale: Bradycardia of 50-70 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. Re-establishment of normal bowel function is delayed into the first postpartum week. A postpartum woman's oral temperature may go as high as 100.4°F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.

Question 5 of 5

The nurse is caring for a client with a diagnosis of ectopic pregnancy. Which diagnostic test is most likely to be ordered?

Correct Answer: C

Rationale: Ultrasound confirms the location of the pregnancy (e.g. outside the uterus) and serial serum hCG levels help diagnose ectopic pregnancy by showing abnormal doubling patterns. Both tests are commonly ordered.

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