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Questions 149

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Extract:


Question 1 of 5

The nurse is suspected of charting medication administration that he did not give. After talking to the nurse, the charge nurse should:

Correct Answer: B

Rationale: Suspected falsification of records warrants a formal reprimand and investigation, but immediate termination or legal action requires further evidence.

Question 2 of 5

A young adult who was in a motorcycle accident is brought to the emergency room with a closed head injury with suspected subdural hematoma. Although the client complains of a severe headache, he is alert and answers questions appropriately. The nurse would question which of the following orders?

Correct Answer: B

Rationale: narcotic analgesic, causes CNS and respiratory depression, contraindicated in head injury because it masks signs of increased intracranial pressure

Question 3 of 5

The primary physiological alteration in the development of asthma is:

Correct Answer: D

Rationale: Bronchiolar smooth muscle spasm is the primary physiological alteration in asthma, leading to airway narrowing.

Question 4 of 5

The home health nurse is scheduled to visit four clients. Which client should she visit first?

Correct Answer: A

Rationale: The AIDS client with fever and cough may have an acute infection like pneumonia, requiring urgent assessment.

Question 5 of 5

A client weighing 150 pounds has received burns over 50% of his body at 1200 hours. Using the Parkland formula, calculate the expected amount of fluid that the client should receive by 2000 hours.

Correct Answer: B

Rationale: Parkland formula: 4 mL × kg × % TBSA. Weight = 150 lb ÷ 2.2 = 68 kg. 4 × 68 × 50 = 13,600 mL total. Half (6,800 mL) is given in the first 8 hours (1200 to 2000).

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