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Questions 164

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Question 1 of 5

The nurse is teaching the parent of a 7-year-old client with celiac disease. Which statement by the parent would require follow-up?

Correct Answer: A

Rationale: Barley contains gluten, which is harmful in celiac disease, indicating a need for further teaching. Rice, corn, potatoes, lifelong gluten-free diet, and avoiding processed foods are correct.

Question 2 of 5

The nurse is caring for a client who reported having thoughts of self-injury yesterday. Which of the following statements by the client should the nurse recognize as risk factors for suicide? Select all that apply.

Correct Answer: A,C,D,F

Rationale: Unemployment, access to firearms, prior overdose, and hopelessness are established suicide risk factors. Marriage with children and religious activities are protective factors.

Question 3 of 5

An unlicensed assistive personnel (UAP), who usually works in pediatrics is assigned to work on a medical-surgical unit. Which one of the questions by the charge nurse would be most appropriate prior to making delegation decisions?

Correct Answer: C

Rationale: The UAP must be competent to accept the delegated task. Further assessment of the qualifications of the UAP is important in order to assign the right task.

Question 4 of 5

The nurse is caring for a client several days following a cerebral vascular accident. Coumadin (warfarin) has been prescribed. Today's prothrombin level is 40 seconds (normal range 10-14 seconds). Which of the following findings requires priority follow-up?

Correct Answer: A

Rationale: The prothrombin time is elevated, indicating a high risk for bleeding. Neurological assessments remain important for post-CVA clients.

Question 5 of 5

A laboring woman prefers to lie in the supine position during labor. The nurse teaches her that this is not a good position for which reason?

Correct Answer: C

Rationale: Supine position can compress the vena cava, causing maternal hypotension and reduced fetal perfusion, leading to fetal heart rate drops.

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