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Questions 163

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Question 1 of 5

The nurse is speaking with the parent of a toddler who believes the child has a hearing deficit. Which findings support this suspected diagnosis? Select all that apply.

Correct Answer: A,C,E

Rationale: Signs of hearing deficit in a toddler include withdrawn behavior , monotone speech , and loud speech due to inability to modulate voice. Inintelligible speech at 12 months is normal, and attentiveness suggests intact hearing.

Question 2 of 5

The nurse would teach a client with Raynaud's phenomenon that, after smoking cessation, it is most important to

Correct Answer: A

Rationale: Avoid caffeine. Caffeine can trigger vasoconstriction, exacerbating Raynaud's phenomenon symptoms, making it a priority after smoking cessation.

Question 3 of 5

The perinatal nurse is reviewing telephone messages from clients. The nurse should first telephone the client who is at

Correct Answer: D

Rationale: Ibuprofen at 32 weeks gestation is concerning due to risks of premature ductus arteriosus closure and oligohydramnios, requiring immediate follow-up. Mild diarrhea and dark urine with metronidazole are less urgent, and acetaminophen is safe.

Question 4 of 5

Which client condition is concerning and requires further nursing observation and intervention? Select all that apply.

Correct Answer: B,D,E

Rationale: Concerning conditions include: spinal cord injury with hypotension suggesting neurogenic shock; black stool and tachycardia indicating possible GI bleeding; and inconsolable neonate with tachycardia suggesting distress. Asthma with hypertension and stable pulse on metoprolol are less urgent.

Question 5 of 5

In preparing medications for a client with a gastrostomy tube, the nurse should contact the health care provider before administering which of the following drugs through the tube?

Correct Answer: A

Rationale: Cardizem SR is a 'sustained-release' drug form. Sustained release (controlled-release, long-acting) drug formulations are designed to release the drug over an extended period of time. If crushed, as would be required for gastrostomy tube administration, sustained-release properties and blood levels of the drug will be altered. The provider must substitute another medication.

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