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Question 1 of 5

The client is admitted with a diagnosis of acute diverticulitis. Which dietary order should the nurse anticipate?

Correct Answer: C

Rationale: A clear liquid diet is ordered during acute diverticulitis to rest the bowel and reduce irritation. High-fiber is for prevention, low-residue is for chronic management, and regular diets are inappropriate.

Question 2 of 5

The nurse is assessing a client with suspected dehydration. Which finding is most indicative?

Correct Answer: B

Rationale: Dry mucous membranes are a classic sign of dehydration due to reduced fluid volume. Decreased (not increased) urine output, tachycardia, and fever may occur but are less specific.

Question 3 of 5

A 32-year-old female client is being treated for Guillain-Barré syndrome. She complains of gradually increasing muscle weakness over the past several days. She has noticed an increased difficulty in ambulating and fell yesterday. When conducting a nursing assessment, which finding would indicate a need for immediate further evaluation?

Correct Answer: C

Rationale: Headaches are not associated with Guillain-Barré syndrome. Loss of superficial and deep tendon reflexes is expected with this diagnosis. Complaints of shortness of breath must be further evaluated. Forty percent of all clients have some detectable respiratory weakness and should be prepared for a possible tracheostomy. Pneumonia is also a common complication of this syndrome. Facial paralysis is expected and is not considered abnormal.

Question 4 of 5

Chorioamnionitis is a maternal infection that is usually associated with:

Correct Answer: A

Rationale: Chorioamnionitis is an inflammation of the chorion and amnion that is generally associated with premature or prolonged rupture of membranes.

Question 5 of 5

The nurse is caring for a client with a tracheostomy. Which action is a priority during tracheostomy care?

Correct Answer: A

Rationale: Cleaning the inner cannula with sterile technique prevents infection and maintains airway patency, a priority. Dressings (
B), suctioning (
C), and tie changes (
D) are secondary.

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