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Questions 158

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Extract:


Question 1 of 5

The nurse notes hyperventilation in a client with a thermal injury. She recognizes that this may be a reaction to which of the following medications if applied in large amounts?

Correct Answer: B

Rationale: Mafenide acetate can cause metabolic acidosis, leading to compensatory hyperventilation. The other medications listed do not typically cause this reaction.

Question 2 of 5

The client has elected to have epidural anesthesia to relieve labor pain. If the client experiences hypotension,the nurse should:

Correct Answer: D

Rationale: Hypotension from epidural anesthesia results from vasodilation. Increasing the IV infusion rate (e.g. with saline) restores blood volume and pressure. Trendelenburg may worsen spinal anesthesia spread and oxygen is secondary unless hypoxia occurs.

Question 3 of 5

When assessing a child with diabetes insipidus, the nurse should be aware of the cardinal signs of:

Correct Answer: B

Rationale: Anemia and vomiting are not cardinal signs of diabetes insipidus. Polyuria and polydipsia are the cardinal signs of diabetes insipidus. Irritability relieved by feeding water, not formula, is a common sign, but not the cardinal sign, of diabetes insipidus. Hypothermia and azotemia are signs, but not cardinal signs, of diabetes insipidus.

Question 4 of 5

A client with a history of chronic venous insufficiency is admitted with complaints of leg ulcers. The nurse should give priority to:

Correct Answer: A

Rationale: Wound care is critical for leg ulcers in chronic venous insufficiency to promote healing and prevent infection.

Question 5 of 5

The nurse observes a client crying quietly. She has just experienced a spontaneous abortion at nine weeks' gestation. An appropriate response by the nurse would be:

Correct Answer: B

Rationale: This response is nontherapeutic because it belittles the client's response and gives a meaningless rationalization. This response acknowledges the client's feelings and demonstrates the therapeutic offering of self by the nurse. This response is nontherapeutic because it does not focus on the client's feelings and offers false reassurance. This response is nontherapeutic because it belittles the client's feelings and offers her advice.

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