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Questions 164

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Question 1 of 5

The nurse is caring for assigned clients. The nurse should first check the client with

Correct Answer: D

Rationale: Pericarditis with paradoxical pulse (
D) suggests tamponade, requiring immediate assessment. Atrial fibrillation (
C), pneumonia (
B), and cirrhosis (
A) are less urgent.

Question 2 of 5

A nurse is collecting data on a 58-year-old client with blurred vision and reduced visual fields. The nurse finds which manifestation most concerning?

Correct Answer: B

Rationale: Extreme eye pain (
B) suggests acute conditions like glaucoma, requiring urgent attention. Difficulty in dim light (
A), peripheral vision loss (
C), and cataracts (
D) are less acute.

Question 3 of 5

Which of the following clients is at highest risk for developing Sarcordosis?

Correct Answer: B

Rationale: Sarcoidosis is most common in African-Americans, particularly women of childbearing age, making the pregnant 30-year-old African-American the highest risk.

Question 4 of 5

The nurse is talking with a client who is scheduled for a lumbar puncture. Which of the following statements by the client would require follow-up?

Correct Answer: A

Rationale: Lumbar punctures are typically performed in a lateral or sitting position, not prone (
A), requiring clarification. Urinating beforehand (
B), needle insertion (
C), and transient pain (
D) are correct.

Question 5 of 5

An 8-year old is admitted with drooling, muffled phonation and a temperature of 102.6°. The nurse should immediately notify the doctor because the child's symptoms are suggestive of:

Correct Answer: B

Rationale: Drooling, muffled phonation, and fever suggest epiglottitis, a medical emergency requiring immediate intervention due to the risk of airway obstruction.

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