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Questions 164

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Question 1 of 5

The school nurse suspects that a third grade child might have attention deficit hyperactivity disorder (ADHD). Prior to referring the child for further evaluation, the nurse should

Correct Answer: C

Rationale: Compile a history of behavior patterns and developmental accomplishments. A comprehensive history is essential for accurate ADHD diagnosis.

Question 2 of 5

The nurse is preparing to administer a scheduled dose of metoclopramide IV to a client with diabetic gastroparesis. Which clinical finding causes the nurse to question the prescription?

Correct Answer: D

Rationale: Sucking lip motions suggest tardive dyskinesia, a contraindication for metoclopramide due to risk of worsening. Diarrhea , burping , and headache are not contraindications.

Question 3 of 5

A woman who is at 39 weeks gestation enters the hospital in early labor. Several hours later, she says, 'What's happening? I suddenly feel as though I have to have a bowel movement.' The woman starts bearing down as if to push out stool. What is the best initial action for the licensed practical nurse at this time?

Correct Answer: B

Rationale: The urge to have a bowel movement and bearing down indicate advanced labor or delivery. Panting prevents pushing, allowing time to assess and prepare for delivery.

Question 4 of 5

A client with psychotic depression is receiving Haldol (haloperidol). Which of the following side effects is associated with antipsychotic medications such as haloperidol?

Correct Answer: A

Rationale: Akathesia , a movement disorder, is a common side effect of haloperidol. Cataracts , diaphoresis , and polyuria are not typically associated.

Question 5 of 5

The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He asks the nurse why he must wait 6 weeks before having sexual intercourse. What is the best response by the nurse to this question?

Correct Answer: B

Rationale: There is a risk of cardiac rupture at the point of the myocardial infarction for about 6 weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by health care providers.

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