Extract:

Question 1 of 5

The nurse is assessing a client with suspected dehydration. Which finding supports this diagnosis?

Correct Answer: B

Rationale: Dry mucous membranes are a classic sign of dehydration due to reduced fluid volume in the body.

Question 2 of 5

A client with a history of type 2 diabetes is prescribed sitagliptin (Januvia). The nurse should instruct the client to:

A. Take the medication with meals. B. Monitor for signs of pancreatitis. C. Take the medication at bedtime. D. Stop the medication if blood glucose normalizes.

Correct Answer: B

Rationale: Sitagliptin can cause pancreatitis, requiring monitoring for abdominal pain.

Question 3 of 5

Identify this cardiac rhythm strip. Fill in the blank. A. Asystole B. Atrial flutter C. Supraventricular Tachycardia D. Premature Atrial Contractions

B. Asystole C. Atrial flutter D. Supraventricular Tachycardia E. Premature Atrial Contractions

Correct Answer: A

Rationale: Asystole is a flatline rhythm indicating no electrical activity, assuming the strip matches this description.

Question 4 of 5

A client with a history of breast cancer is prescribed tamoxifen (Nolvadex). Which side effect should the nurse teach the client to report?

A. Hot flashes B. Weight gain C. Vaginal bleeding D. Fatigue

Correct Answer: C

Rationale: Vaginal bleeding may indicate endometrial hyperplasia or cancer, a serious side effect of tamoxifen requiring immediate reporting.

Question 5 of 5

The nurse is giving care to an infant in an oxygen hood (see figure). The nurse should do which of the following. Select all that apply.

A. Assure that the oxygen is not blowing directly on the infant’s face. B. Place the butterfl y mobile on the outside of the hood. C. Immobilize the infant with restraints. D. Remove the hood for 10 minutes every hour. E. Encourage the parents to visit the child.

Correct Answer: A,B,E

Rationale: When an oxygen hood is used, the nurse should be sure the oxygen source is not directed on the infant’s face to avoid skin irritation. Mobiles can be used to provide visual stimulation, but they should not be placed inside of the hood where they are a potential choking hazard. It is not necessary to restrain the infant unless there is an indication to do so, and the physician has written the order. There should be as little movement in and out of the hood as possible in order to maintain the warm and humid oxygen levels. The nurse should encourage the parents to visit the child and provide verbal and tactile stimulation.