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Questions 149

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Question 1 of 5

What would the nurse expect the admitting assessment to reveal in a client with glomerulonephritis?

Correct Answer: A

Rationale: Glomerulonephritis often causes hypertension due to fluid retention and renal dysfunction.

Question 2 of 5

A client with a tracheostomy is exhibiting difficulty breathing, and respirations are increasingly noisy. Secretions are very thick. Which of the following initial interventions is most indicated?

Correct Answer: A

Rationale: Thick secretions causing noisy respirations and breathing difficulty indicate the need for increased humidification to thin secretions and suctioning to clear the tracheostomy tube (
A). Notifying the physician (
B) or encouraging coughing (
C) is secondary, and irrigation (
D) is not typically the initial step.

Question 3 of 5

A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:

Correct Answer: A

Rationale: Elevating the arm on pillows reduces edema and promotes lymphatic drainage post-mastectomy, aiding recovery.

Question 4 of 5

Heparin has been ordered for a client with pulmonary embolis. Which statement, if made by the graduate nurse, indicates a lack of understanding of the medication?

Correct Answer: D

Rationale: Aspirating during heparin injection is incorrect, as it increases the risk of hematoma formation in subcutaneous administration.

Question 5 of 5

If a client with psoriasis is to begin NB-UVB phototherapy, how long should the initial treatment be?

Correct Answer: A

Rationale: Initial NB-UVB phototherapy starts with 30 seconds to 1 minute (
A) to assess skin tolerance and prevent burns. Longer durations (B, C,
D) are used in subsequent sessions.

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