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Questions 164

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Question 1 of 5

The nurse is assigned to care for 4 clients. Which of the following should be assessed immediately after hearing the report?

Correct Answer: B

Rationale: The client with a peptic ulcer who has been vomiting all night. Persistent vomiting can lead to dehydration, electrolyte imbalances, and potential complications such as perforation or bleeding in a client with a peptic ulcer, requiring immediate assessment.

Question 2 of 5

The nurse is discussing preventive health care with a group of women. Which woman should the nurse advise to have a mammogram?

Correct Answer: D

Rationale: Mammograms are recommended starting at age 50 for asymptomatic women per standard guidelines, making the 52-year-old the priority.

Question 3 of 5

A new mother is two days postpartum, is breastfeeding her infant, and now is preparing for discharge. She states that for contraception she is going to use her diaphragm, which she still has. The nurse's response should be based on which information?

Correct Answer: A

Rationale: Postpartum pelvic changes require diaphragm refitting to ensure effective contraception, as size may differ after childbirth.

Question 4 of 5

A client's admission urinalysis shows the specific gravity value of 1.039. Which of the following assessment data would the nurse expect to find when assessing this client?

Correct Answer: C

Rationale: Poor skin turgor. The specific gravity value is high, indicating dehydration. Poor skin turgor (tenting of the skin) is consistent with this problem.

Question 5 of 5

During the admission bath, the nurse notes a region of impaired skin under a large sacral dressing. Which of the following actions by the nurse are appropriate? Select all that apply.

Question Image

Correct Answer: A,C,D,E

Rationale: A nutrient-rich diet (
A) supports wound healing. Cleansing with saline (
C) prevents infection. A hydrophilic dressing (
D) promotes a moist healing environment. Frequent repositioning (E) reduces pressure on the impaired skin.

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