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Questions 149

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Question 1 of 5

The physician has ordered a paracentesis for a client with severe abdominal ascites. Before the procedure, the nurse should:

Correct Answer: A

Rationale: Providing a urinal allows the client to empty their bladder, reducing the risk of bladder puncture during paracentesis.

Question 2 of 5

The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are good sources of B12?

Correct Answer: A

Rationale: Vitamin B12 is found in animal products like meat, eggs, and dairy, essential for treating pernicious anemia due to impaired B12 absorption.

Question 3 of 5

As the client reaches 6cm dilation, the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?

Correct Answer: D

Rationale: Late decelerations indicate uteroplacental insufficiency, reducing fetal oxygenation during contractions.

Question 4 of 5

When using restraints for an agitated/aggressive patient, which of the following statements should NOT influence the nurse’s actions during this intervention?

Correct Answer: C

Rationale: the need for restraints is based on patient’s behavioral status and condition, not the patient’s voluntary/involuntary status

Question 5 of 5

The nurse is caring for a client who is postoperative day 2 following a cholecystectomy. The client reports nausea and has not had a bowel movement since surgery. Which of the following actions should the nurse take FIRST?

Correct Answer: D

Rationale: assessment of bowel sounds is the first step to determine if there is a postoperative ileus or other complication

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