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Questions 149

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Extract:


Question 1 of 5

The nurse is caring for a client with depression over the recent death of her father from cancer. The client states, 'It's my fault. I should have insisted he get regular checkups instead of letting him put it off.' The nurse responds, 'You feel like it's your fault?' Which therapeutic communication technique is the nurse using?

Correct Answer: B

Rationale: Reflecting mirrors the client’s feelings, encouraging further expression and exploration of emotions.

Question 2 of 5

Which instruction would not be included in the discharge teaching of the client receiving chlorpromazine (Thorazine)?

Correct Answer: B

Rationale: Avoiding aged cheese is relevant for MAO inhibitors, not chlorpromazine, which does not interact with tyramine-containing foods.

Question 3 of 5

The nurse is preparing to administer a dose of morphine sulfate to a client with postoperative pain. The client’s respiratory rate is 10 breaths per minute. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: a respiratory rate of 10 breaths per minute is low, and morphine can further depress respiration, so the dose should be withheld

Question 4 of 5

A 2-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?

Correct Answer: A

Rationale: Currant jelly stools, caused by blood and mucus, are a hallmark of intussusception due to intestinal obstruction.

Question 5 of 5

An 82-year-old woman is being admitted to a long-term care facility. Her assigned nurse completes a full assessment, including calculating the risk for skin breakdown based on the Braden Scale. To determine a Braden Scale score, the nurse evaluates all of the following EXCEPT

Correct Answer: C

Rationale: The Braden Scale assesses sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Past history of skin breakdown is not a scored category.

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