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Questions 149

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Question 1 of 5

The nurse is caring for a postpartum client 2 hours post-delivery who is unable to void. Which of the following nursing interventions should be considered initially?

Correct Answer: D

Rationale: Palpating the bladder assesses for distention, which may indicate urinary retention, guiding further interventions without immediately resorting to invasive measures.

Question 2 of 5

The nurse is infusing total parenteral nutrition (TPN) through a peripherally inserted central catheter. The client's TPN was turned off for 1 hour for an MRI. Which action by the nurse is most appropriate for this client?

Correct Answer: A

Rationale: Notifying the provider ensures proper adjustment of TPN administration, as altering rates or discarding solution can cause metabolic imbalances.

Question 3 of 5

A patient refuses to take his dose of oral medication. The nurse tells the patient that if he does not take the medication that she will administer it by injection. The nurse's comments can result in a charge of:

Correct Answer: B

Rationale: Threatening to administer medication by injection against the patient's will constitutes assault, as it involves a threat of unwanted contact.

Question 4 of 5

When gathering evidence from a victim of rape, the nurse should place the victim's clothing in a:

Correct Answer: C

Rationale: A paper bag allows air circulation, preventing moisture that could degrade biological evidence.

Question 5 of 5

The client taking Glyburide (Diabeta) should be cautioned to:

Correct Answer: D

Rationale: Daily glucose monitoring is essential for clients on Glyburide to manage blood sugar levels effectively.

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