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Questions 164

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Question 1 of 5

The nurse is assessing a 4 year-old for possible developmental dysplasia of the right hip. Which finding would the nurse expect?

Correct Answer: D

Rationale: Characteristic limp. Developmental dysplasia produces a characteristic limp in children who are walking, indicating hip joint instability.

Question 2 of 5

The nurse practicing on a long-term care unit cares for a client with type 1 diabetes mellitus. Which action should the nurse assign to experienced unlicensed assistive personnel?

Correct Answer: A

Rationale: Checking blood glucose and reporting results is within UAP scope if trained. Teaching, monitoring for hypoglycemia, and updating care plans require nursing judgment and are outside UAP scope.

Question 3 of 5

The nurse is preparing to administer ear drops to an adult client. It would require follow-up if the nurse

Correct Answer: B

Rationale: Placing the dropper into the ear canal risks injury and contamination. Ear drops should be instilled by holding the dropper above the canal. Other actions are correct: room-temperature drops prevent discomfort, pulling the pinna straightens the canal, and a cotton ball retains the medication.

Question 4 of 5

Following change-of-shift report on an orthopedic unit, which client should the nurse see first?

Correct Answer: C

Rationale: Look for the client who has the most imminent risks and acute vulnerability. The client who returned from surgery 2 hours ago is at risk for life threatening hemorrhage and should be seen first.

Question 5 of 5

An older adult is diagnosed with open-angle glaucoma. Which comment by the client indicates understanding of the management of the condition?

Correct Answer: A

Rationale: Daily eye drops control intraocular pressure in open-angle glaucoma, a chronic condition, indicating understanding, unlike expecting a cure, contagiousness, or immediate surgery.

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