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Questions 158

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Extract:


Question 1 of 5

The client is admitted with a diagnosis of gestational hypertension. Which vital sign change is most concerning?

Correct Answer: A

Rationale: A blood pressure of 160/110 indicates severe gestational hypertension increasing the risk of complications like stroke or eclampsia and requires immediate intervention. The other vital signs are normal.

Question 2 of 5

The physician has ordered a low-sodium diet for a client with hypertension. Which food should the nurse instruct the client to avoid?

Correct Answer: C

Rationale: Canned soups are high in sodium, which exacerbates hypertension. Fresh fruit, grilled chicken, and brown rice are low-sodium options suitable for a hypertension diet.

Question 3 of 5

Which of the following is a late sign associated with oral cancer?

Correct Answer: C

Rationale: Pain is a late sign of oral cancer, often occurring as the tumor invades deeper tissues or nerves. Early signs include ulcers or white/red patches, while warmth and odor are less specific, and flat-edged ulcers are not typical.

Question 4 of 5

Which of the following nursing diagnoses is of highest priority for the patient with hypothyroidism?

Correct Answer: D

Rationale: Hypothyroidism reduces metabolic rate potentially decreasing cardiac output which can lead to life-threatening complications like heart failure. While hypothermia and other diagnoses are relevant decreased cardiac output is the most critical.

Question 5 of 5

A two-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?

Correct Answer: A

Rationale: Currant jelly stools (bloody, mucousy) are classic in intussusception due to intestinal ischemia. Vomiting and a palpable abdominal mass may occur, but stools and flank masses are less specific.

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