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Questions 164

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Extract:


Question 1 of 5

The nurse prepares a 7-year-old client for an influenza injection. The nurse explains that the client will receive 'medicine under the skin,' and the client is visibly anxious. Which nursing intervention is appropriate?

Correct Answer: D

Rationale: Hiding the needle (
D) reduces anxiety. Counting (
A) may not distract enough, holding arms (
B) can increase fear, and denying pain (
C) is dishonest.

Question 2 of 5

The nurse is caring for a college football player who recently sustained an accidental, forceful, helmet-to-helmet collision with another running football player. Which sign/symptom is most concerning and alerts the practical nurse to contact the registered nurse immediately?

Correct Answer: B

Rationale: A 'halo' across vision (
B) suggests a serious neurological issue, such as a concussion or brain injury, requiring immediate attention. Epistaxis (
A), emesis (
C), and headache (
D) are concerning but less urgent unless persistent or worsening.

Question 3 of 5

The mother of a newborn asks why the nurse is checking the baby's nose. The nurse replies that it is important to check nasal patency because the newborn:

Correct Answer: B

Rationale: Newborns are obligate nose breathers, making nasal patency critical to prevent respiratory distress. Sneezing ability, apnea, or rapid respirations are unrelated.

Question 4 of 5

The nurse answers a call light on a client not assigned to the nurse. The client, who was just admitted from the emergency department, requests a cup of coffee. What is the appropriate intervention?

Correct Answer: D

Rationale: Suggesting water (
D) is safe until dietary orders are confirmed. Coffee (A,
C) may be contraindicated, and waiting (
B) doesn't address the request.

Question 5 of 5

The nurse reinforces education about safety modifications in the home for the spouse of a client diagnosed with Alzheimer disease. What instructions should the nurse include?

Correct Answer: A,B,C,D

Rationale: Clear pathways (
A), accessible items (
B), locked doors (
C), and bathroom symbols (
D) enhance safety. A dark room (E) may increase confusion or fear.

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