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Questions 158

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Extract:


Question 1 of 5

The first action that the nurse should take if she finds the client has an O2 saturation of 68% is:

Correct Answer: C

Rationale: An O2 saturation of 68% indicates severe hypoxemia requiring immediate oxygen administration (e.g. via mask) to restore oxygenation. Elevating the head rechecking later or assessing heart rate are secondary to correcting hypoxia.

Question 2 of 5

The client is admitted with a diagnosis of abruptio placenta. Which complication is most likely to occur?

Correct Answer: C

Rationale: Abruptio placenta causes placental separation leading to fetal distress (from hypoxia) and maternal hemorrhage (from bleeding). Both are common and serious complications.

Question 3 of 5

The nurse is caring for a client with a diagnosis of abruptio placenta. Which intervention is most appropriate?

Correct Answer: A

Rationale: Abruptio placenta can cause fetal hypoxia making fetal heart tone monitoring critical to assess fetal well-being.
Tocolytics are contraindicated Trendelenburg may worsen bleeding and antibiotics are not indicated unless infection is present.

Question 4 of 5

During discharge planning, parents of a child with rheumatic fever should be able to identify which of the following as toxic symptoms of sodium salicylate?

Correct Answer: A

Rationale: These are toxic symptoms of sodium salicylate. (B, C,
D) These are not symptoms associated with sodium salicylate.

Question 5 of 5

The client is admitted with a diagnosis of abruptio placenta. Which diagnostic test is most likely to be ordered?

Correct Answer: C

Rationale: Ultrasound can confirm placental separation in abruptio placenta and fetal heart monitoring assesses for distress due to hypoxia. Both tests are critical for diagnosis and management.

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