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Questions 148

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Question 1 of 5

The nurse is caring for a patient with a colostomy. The patient asks, 'Will I ever be able to swim again?' The nurse's best response would be:

Correct Answer: A

Rationale: Swimming is possible with a colostomy if proper precautions, like a waterproof seal, are used to protect the stoma.

Question 2 of 5

The nurse is performing an initial assessment of a newborn Caucasian male delivered at 32 weeks gestation. The nurse can expect to find the presence of:

Correct Answer: C

Rationale: Head lag is expected in a preterm newborn at 32 weeks due to underdeveloped neck muscle strength.

Question 3 of 5

The physician has ordered a lumbar puncture for a client with suspected Guillain-Barre syndrome. The spinal fluid of a client with Guillain-Barre syndrome typically shows:

Correct Answer: B

Rationale: Guillain-Barre syndrome typically shows elevated protein levels in cerebrospinal fluid with a normal cell count, known as albuminocytologic dissociation.

Question 4 of 5

The nurse is caring for a client who is postoperative day 3 following a bowel resection. The client reports sudden, severe abdominal pain and distention. Which of the following actions should the nurse take FIRST?

Correct Answer: B

Rationale: sudden, severe abdominal pain and distention may indicate a complication such as an anastomotic leak, requiring immediate physician notification

Question 5 of 5

The nurse is caring for a client with a history of spinal cord injury who is admitted with a urinary tract infection. Which of the following interventions should the nurse implement?

Correct Answer: B

Rationale: antibiotics are the primary treatment for a urinary tract infection

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