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Questions 164

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Question 1 of 5

The nurse is preparing to instill dialysate for a client who is receiving peritoneal dialysis. It would be a priority for the nurse to

Correct Answer: C

Rationale: Sterile technique when spiking and attaching the dialysate bag prevents peritonitis, a life-threatening complication. Semi-Fowler positioning, recording output, and bag placement are important but secondary to infection prevention.

Question 2 of 5

The nurse in a well-child clinic examines many children on a daily basis. Which of the following toddlers requires further follow up?

Correct Answer: D

Rationale: A 30 month-old only drinking from a sippy cup. A 30 month-old should be able to drink from a cup without a cover.

Question 3 of 5

The nurse observes a client self-administering nasal fluticasone. Which observation would require the practical nurse to intervene and reinforce the instructions provided by the registered nurse?

Correct Answer: B

Rationale: Pointing fluticasone toward the nasal septum risks irritation or bleeding; it should be aimed laterally. Sitting with head forward, occluding the other nostril, and inhaling deeply are correct administration techniques.

Question 4 of 5

A client who is blind is admitted to the hospital for surgery tomorrow. The client is able to get out of bed and eat until midnight. Which nursing action is most appropriate?

Correct Answer: A

Rationale: Describing surroundings aids orientation and safety for a blind client, promoting independence. Side rails, voice descriptions, or removing objects are less helpful.

Question 5 of 5

A culture is taken of a lesion suspected of being herpes. The nurse knows that the specimen:

Correct Answer: A

Rationale: Herpes culture specimens should be packed on ice to preserve the virus for accurate laboratory testing.

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