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Questions 164

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Question 1 of 5

The nurse is reinforcing discharge teaching for a client who has a low health literacy level. Which of the following actions should the nurse take? Select all that apply.

Correct Answer: B,C,D

Rationale: Teach-back confirms understanding, repeating key points reinforces learning, and visual aids simplify concepts. Excessive detail overwhelms low-literacy clients, and loud speech is unnecessary unless hearing-impaired.

Question 2 of 5

The nurse is observing a 3-year-old client for expected developmental milestones. It would require follow-up if the client cannot

Correct Answer: B

Rationale: Copying a square is expected by age 4-5, not 3, indicating a fine motor delay requiring follow-up. Catching a ball, eating with a spoon, and hopping are age-appropriate or slightly advanced for a 3-year-old.

Question 3 of 5

The nurse is caring for several hospitalized children with the following diagnoses. Which disorder is likely to result in metabolic acidosis?

Correct Answer: A

Rationale: Severe diarrhea is the only problem listed that can lead to metabolic acidosis if untreated.

Question 4 of 5

An adult client who is ambulating in the corridor with the nurse becomes dizzy and faint. What should the nurse do at this time?

Correct Answer: C

Rationale: Guiding the client to a chair prevents falls and ensures safety during dizziness. Head positioning, seeking help, or faster walking are unsafe or impractical.

Question 5 of 5

The nurse admits a 7 year-old to the emergency room after a leg injury. The x-rays show a femur fracture near the epiphysis. The parents ask what will be the outcome of this injury. The appropriate response by the nurse should be which of these statements?

Correct Answer: B

Rationale: An epiphyseal (growth) plate fracture in a 7 year-old often results in retarded bone growth. The leg often will be different in length than the uninjured leg.

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