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Questions 160

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Question 1 of 5

The nurse is caring for a client with a new colostomy. Which statement by the client indicates a need for further teaching?

Correct Answer: B

Rationale: High-fiber foods can cause blockages in a new colostomy; low-residue foods are recommended initially.

Question 2 of 5

Which nursing intervention is most appropriate for meeting the needs of an infant with congenital heart disease?

Correct Answer: A

Rationale: Responding quickly to crying minimizes stress and oxygen demand in an infant with congenital heart disease.

Question 3 of 5

A pregnant client with known human immunodeficiency virus (HIV) infection is admitted to the hospital in active labor. Which method of fetal assessment is most appropriate?

Correct Answer: C

Rationale: External fetal monitoring is non-invasive, minimizing HIV transmission risk during labor compared to invasive methods.

Question 4 of 5

During the first stage of a client's labor, the nurse finds that the fetal heart rate decreases during a contraction and returns to normal at the end of the contraction. Which action is the most appropriate in response to the assessment finding?

Correct Answer: A

Rationale: A temporary fetal heart rate decrease during contractions (early deceleration) is normal, indicating head compression, and requires no action.

Question 5 of 5

The clinic nurse is reviewing the history of the client diagnosed with bacterial vaginosis (BV). Which identified disorder places the client at a higher risk of developing BV?

Correct Answer: D

Rationale: A. Gastroesophageal reflux disorder is not a risk factor for BV. B. Hypothyroidism does affect the reproductive system. However, it does not specifically alter the pH of the vagina, which could increase the incidence of BV. C. Cardiovascular disease is not a risk factor for BV. D. Diabetes is a risk factor for a variety of vulvovaginal infections.

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