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Questions 149

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Extract:


Question 1 of 5

The nurse is infusing total parenteral nutrition (TPN). The primary purpose for closely monitoring the client's intake and output is:

Correct Answer: D

Rationale: Monitoring intake and output during TPN helps prevent fluid overload, a risk due to the high volume and osmolarity of the solution.

Question 2 of 5

A client has accidentally splashed a toxic (although not caustic) substance in his right eye and the nurse must flush the eye. Which of the following steps are correct? Select all that apply.

Correct Answer: B,C,D,E

Rationale: Correct eye irrigation includes syringe 0.5 inch above eye (
B), flushing 5 minutes (
C), holding eyelid open (
D), and using a basin (E). Head down (
A) is incorrect; tilt toward affected side.

Question 3 of 5

An 8-year-old boy is diagnosed with a Wilm's tumor. The nurse would expect what finding on assessment?

Correct Answer: D

Rationale: Wilm’s tumor (nephroblastoma) often presents with an enlarged abdomen due to a palpable renal mass.

Question 4 of 5

Which task is included in the working phase of the nurse-client relationship?

Correct Answer: C

Rationale: The working phase involves evaluating progress toward goals, building on strengths identified earlier.

Question 5 of 5

The nurse recognizes all of the following as common physical characteristics of a child with Down syndrome EXCEPT

Correct Answer: D

Rationale: Down syndrome features include small, low-set ears, downward slanting eyes, and hyperflexibility. An enlarged tongue (macroglossia) is less common or not a hallmark feature.

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