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Questions 148

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Question 1 of 5

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

Correct Answer: B

Rationale: decreased breath sounds on the affected side are a hallmark of pneumothorax due to lung collapse

Question 2 of 5

A client with newly diagnosed type I diabetes mellitus is being seen by the home health nurse. The physician orders include: 1,200-calorie ADA diet, 15 units of NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the client at 5 PM, the nurse observes the man performing a blood sugar analysis. The result is 50 mg/dL. The nurse would expect the client to be

Correct Answer: A

Rationale: symptoms of hypoglycemia, normal blood sugar 70-110 mg/dL

Question 3 of 5

The nurse is observing the respirations of a client when she notes that the respiratory cycle is marked by periods of apnea lasting from 10 seconds to 1 minute. The apnea is followed by respirations that gradually increase in depth and frequency. The nurse should document that the client is experiencing:

Correct Answer: A

Rationale: Cheyne-Stokes respirations are characterized by periods of apnea followed by increasing depth and frequency of breaths.

Question 4 of 5

What is the critical point for PO2 (the 'ICU' point), the percentage point at which there is marked decrease in oxygen saturation? Record your answer using a whole number.

Correct Answer: 90

Rationale: The critical PO2 point is around 90 mmHg, where oxygen saturation drops significantly, often requiring ICU intervention.

Question 5 of 5

The nurse is evaluating nutritional outcomes for a client with anorexia nervosa. Which one of the following is the most objective favorable outcome for the client?

Correct Answer: C

Rationale: Weight gain is the most objective and measurable outcome for anorexia nervosa, indicating improved nutritional status and progress toward recovery.

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