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Question 1 of 5

The nurse is caring for a client with a history of fibromyalgia. The nurse should expect the client to have:

Correct Answer: A

Rationale: Fibromyalgia causes widespread musculoskeletal pain, often accompanied by fatigue and tender points.

Question 2 of 5

The nurse is caring for a 2-year-old girl with a subdural hematoma of the temporal area as a result of falling out of bed and notices that she has a runny nose. The nurse should:

Correct Answer: C

Rationale: The nasal discharge could be due to a cold. It is necessary to gather additional assessment data to identify a possible cerebrospinal fluid leak. If the discharge is cerebrospinal fluid, it would not be safe to encourage the girl to blow her nose. Cerebrospinal fluid is positive for sugar; mucus is not. Turning her to her side will have no effect on her 'runny nose.' It is necessary to gather further assessment data.

Question 3 of 5

At 30 weeks' gestation, a client is admitted to the unit in premature labor. Her physician orders that an IV be started with 500 mL D5W mixed with 150 mg of ritodrine stat. The RN prepares the IV solution with the medication. The RN knows that clients receiving the medication ritodrine IV should be observed closely for which one of the following side effects:

Correct Answer: C

Rationale: Ritodrine is a sympathomimetic β2-adrenergic agonist that can cause vasodilation, leading to hypotension. The body compensates by increasing heart rate, resulting in tachycardia.

Question 4 of 5

A client with a history of a fractured femur is in skeletal traction. The nurse should:

Correct Answer: B

Rationale: Cleaning pin sites with saline (or per protocol) prevents infection in skeletal traction. Turning is limited, lotion is unnecessary, and removing weights disrupts traction.

Question 5 of 5

The nurse is teaching a client with type 1 diabetes about insulin administration. The nurse should tell the client to:

Correct Answer: C

Rationale: Rotating injection sites prevents lipodystrophy and ensures consistent insulin absorption, a critical teaching point for type 1 diabetes management.

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The nurse would be sure to instruct a client on the signs and symptoms of an eye infection and hemorrhage. These signs and symptoms would include:
A 27-year-old primigravida stated that she got up from the chair to fix dinner and bright red blood was running down her legs. She denies any pain previously or currently. The client is very concerned about whether her baby will be all right. Her vital signs include P 120 bpm, respirations 26 breaths/min, BP 104/58 mm Hg, temperature 98.2_F, and fetal heart rate 146 bpm. Laboratory findings revealed hemoglobin 9.0 g/dL, hematocrit 26%, and coagulation studies within normal range. On admission, the peripad she wore was noted to be half saturated with bright red blood. A medical diagnosis of placenta previa is made. The priority nursing diagnosis for this client would be:
A client with a history of a C4 spinal cord injury is being prepared for discharge. Before discharge, the nurse should make sure that the client can:
The patient is prescribed metronidazole (Flagyl) for adjunct treatment for a duodenal ulcer. When teaching about this medication, the nurse would include:

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