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Questions 164

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Question 1 of 5

The nurse is assessing a client with portal hypertension. Which of the following findings would the nurse expect?

Correct Answer: C

Rationale: Ascites. Portal hypertension can occur in a client with right-sided heart failure or cirrhosis of the liver. Portal hypertension can lead to ascites due to the increased portal pressure as well as a lowered colloid osmotic pressure because of low albumin. When liver functioning deteriorates, protein metabolism suffers.

Question 2 of 5

The nurse is caring for assigned clients. The nurse should first check the client with

Correct Answer: A

Rationale: Severe pain (9/10) in sickle cell disease indicates a possible vaso-occlusive crisis, a medical emergency requiring immediate assessment. Fever, tachycardia, and hyperglycemia are less urgent.

Question 3 of 5

The nurse is assessing a client's home in preparation for discharge. Which of the following should be given priority consideration?

Correct Answer: A

Rationale: Functional communication patterns between family members are fundamental to meeting the needs of the client and family.

Question 4 of 5

A patient has been ordered to get Tegretol for the first time. Which of the following side effects is not associated with Tegretol?

Correct Answer: D

Rationale: A-C are associated side effects of Tegretol.

Question 5 of 5

A client visiting a family planning clinic is suspected of having an STD. The most diagnostic test for all stages of treponema pallidum (syphilis) is the:

Correct Answer: C

Rationale: The FTA-Abs test is the most specific and diagnostic for all stages of syphilis. VDRL and RPR are non-treponemal tests that can have false positives, so A and B are incorrect. Thayer-Martin culture is used for gonorrhea, so D is incorrect.

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