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Questions 164

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Question 1 of 5

The nurse is caring for a client who has gastroesophageal reflux disease and has been receiving long-term omeprazole therapy. The nurse should recognize that the client is at highest risk for developing

Correct Answer: D

Rationale: Long-term omeprazole increases risk of C. difficile due to altered gut flora. Jaw necrosis , vision changes , and gait disturbance are not associated.

Question 2 of 5

The nurse is inserting an indwelling urinary catheter for a female client. Which of the following actions should the nurse take? Select all that apply.

Correct Answer: A,B,D

Rationale: Spreading labia aids visualization. Sterile gloves and drape maintain sterility. Proper positioning facilitates insertion. Advancing only 2 inches is insufficient (should be 5-7 cm) before balloon inflation. Cleansing should start with the meatus , not labia.

Question 3 of 5

The nurse is reinforcing postpartum discharge instructions to a client. Which instruction should the nurse include to promote newborn safety?

Correct Answer: D

Rationale: Removing pillows and blankets from the crib reduces SIDS risk. Blankets in car seats are unsafe, prone sleeping increases SIDS risk, and forward-facing car seats are incorrect for newborns.

Question 4 of 5

A client with psychotic depression is receiving Haldol (haloperidol). Which of the following side effects is associated with antipsychotic medications such as haloperidol?

Correct Answer: A

Rationale: Akathesia , a movement disorder, is a common side effect of haloperidol. Cataracts , diaphoresis , and polyuria are not typically associated.

Question 5 of 5

Which of the following nursing assessment findings require immediate discontinuance of an antipsychotic medication?

Correct Answer: D

Rationale: Hyperpyrexia, severe muscle rigidity, and malignant hypertension are signs of neuroleptic malignant syndrome (NMS), requiring immediate discontinuation of the antipsychotic.

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