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Questions 158

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Extract:


Question 1 of 5

The nurse is caring for a client with a history of congestive heart failure. The nurse should give priority to:

Correct Answer: A

Rationale: Congestive heart failure increases the risk of arrhythmias due to cardiac strain, making monitoring for arrhythmias a priority to prevent sudden cardiac events.

Question 2 of 5

A family by court order undergoes treatment by a family therapist for child abuse. The nurse, who is the child's case manager knows that treatment has been effective when:

Correct Answer: D

Rationale: Removing an abused child from the home and placement in a foster home are not the desired outcome of treatment. Children who are perceived as 'different' from the rest of the family are more likely to be abused. Although legal action may be taken against abusive parents, it is not an indicator of an effective treatment program. Identification of age-appropriate behaviors is essential to the role of parents, because misunderstanding children's normal developmental needs often contributes to abuse or neglect.

Question 3 of 5

Place in sequence from 1-5 the proper order for introducing items to the infant's diet.

Order the Items

Source Container

Strained meats
Whole milk
Rice cereal
Fruits
Vegetables

Correct Answer: C, D, E, A, B

Rationale: Infant diet sequence: rice cereal (
C) at 6 months, then fruits (
D) and vegetables (E), strained meats (
A) around 7-8 months, and whole milk (
B) after 12 months.

Question 4 of 5

The mother of a six-year-old with autistic disorder tells the nurse that her son has been much more difficult to care for since the birth of his sister. The best explanation for changes in the child's behavior is:

Correct Answer: C

Rationale: Children with autism often rely on structured routines, and disruptions, such as a new sibling, can lead to behavioral changes due to difficulty adapting to change.

Question 5 of 5

A client with a history of trigeminal neuralgia is admitted with complaints of facial pain. The nurse should give priority to:

Correct Answer: A

Rationale: Trigeminal neuralgia causes severe facial pain, so administering analgesics is the priority to relieve discomfort.

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