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Questions 149

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Question 1 of 5

The nurse is caring for clients on a respiratory unit. Upon receiving the following client reports, which client should be seen first?

Correct Answer: C

Rationale: Edema and neck vein distention in a bronchitis client suggest heart failure, a critical condition requiring immediate assessment. The other clients are stable or less urgent.

Question 2 of 5

A public health nurse is preparing an educational handout about rubella, commonly known as measles. All of the following statements should be included in the informational handout EXCEPT

Correct Answer: B

Rationale: Rubella’s incubation period is 12-23 days, not 3-7 days. It spreads via respiratory droplets (coughing/sneezing), not skin-to-skin. Symptoms include fever and rash, but runny nose and cough are more typical of measles.

Question 3 of 5

A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

Correct Answer: B

Rationale: Hydration is the highest priority in sickle cell crisis to prevent further sickling of red blood cells and to promote blood flow, reducing the risk of complications.

Question 4 of 5

The nurse is precepting a student nurse on an orthopedic floor. The student nurse needs to insert an indwelling catheter into a male client. Which of the following statements by the student nurse are correct regarding insertion of the catheter? Select all that apply.

Correct Answer: A,B,C

Rationale: Aseptic technique, supine positioning, and sterile lubrication are correct for catheter insertion. Inflating the balloon with 5 cc is incorrect, as most catheters require 10 cc of sterile water for balloon inflation.

Question 5 of 5

Which play activity is best suited to the gross motor skills of the toddler?

Correct Answer: B

Rationale: Playing with a ball encourages gross motor skills like kicking and throwing, suitable for a toddler's developmental stage.

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