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Questions 158

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Question 1 of 5

The nurse is caring for a client with a history of a pulmonary embolism. The client is receiving Heparin. The nurse should monitor the client for:

Correct Answer: A

Rationale: Heparin, an anticoagulant, increases bleeding risk, including bleeding gums. Hypertension, tachypnea, and fever are not directly related to heparin therapy.

Question 2 of 5

A client with a diagnosis of Amyotrophic Lateral Sclerosis (ALS) has been prescribed riluzole (Rilutek). Which does the nurse include when teaching the client about this drug?

Question Image

Correct Answer: A, C, D, E

Rationale: Riluzole teaching includes avoiding alcohol (
A), reporting fever (
C), consistent timing (
D), and regular lab monitoring (E). Taking with food (
B) is not required.

Question 3 of 5

A student nurse is observing a neurological nurse perform an assessment. When the nurse asks the client to "stick out his tongue," the nurse is assessing the function of which cranial nerve?

Correct Answer: D

Rationale: The hypoglossal nerve (XII) controls tongue movement. Sticking out the tongue assesses its function. Optic (II) affects vision, olfactory (I) affects smell, and vagus (X) affects visceral functions.

Question 4 of 5

A common complaint of the client with an abdominal aortic aneurysm is:

Correct Answer: D

Rationale: A pulsating sensation in the periumbilical area is a classic symptom of an abdominal aortic aneurysm due to the expanding vessel. The other symptoms are less specific or unrelated.

Question 5 of 5

A female client with major depression stated that 'life is hopeless and not worth living.' The nurse should place highest priority on which of the following questions?

Correct Answer: B

Rationale: Maintenance of the client's life is the priority; assessment of suicidal intent is imperative.

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