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Questions 158

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Question 1 of 5

The nurse is caring for a client with a T4 spinal cord injury. The client complains of a pounding headache. The nurse should:

Correct Answer: A

Rationale: A pounding headache in a T4 spinal cord injury suggests autonomic dysreflexia, often triggered by bladder or bowel issues, causing severe hypertension. Checking blood pressure is the priority to confirm.

Question 2 of 5

The doctor has prescribed aspirin 325 mg daily for a client with transient ischemic attacks. The nurse explains that aspirin was prescribed to:

Correct Answer: D

Rationale: Aspirin reduces platelet aggregation, preventing clot formation in transient ischemic attacks, reducing stroke risk. It does not prevent headaches, boost coagulation, or directly prevent anoxia.

Question 3 of 5

A client is hyperactive and not sleeping. She will not remain at the table during mealtime. She is getting very limited calories and is using a lot of energy in her hyperactive state. The most therapeutic nursing action is to:

Correct Answer: C

Rationale: Providing finger foods increases the likelihood of eating for hyperactive persons. They may be eating 'on the run,' accommodating their high energy state.

Question 4 of 5

Chorioamnionitis is a maternal infection that is usually associated with:

Correct Answer: A

Rationale: Chorioamnionitis is an inflammation of the chorion and amnion that is generally associated with premature or prolonged rupture of membranes.

Question 5 of 5

Which of the following is a classic manifestation of glomerulonephritis?

Correct Answer: A

Rationale: Hypertension is a classic manifestation of glomerulonephritis due to fluid retention and renal dysfunction. Lassitude and fatigue may occur but are less specific and vomiting/diarrhea are not typical.

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