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Questions 149

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Extract:


Question 1 of 5

Which nursing assessment indicates that involutional changes have occurred in a client who is 3 days postpartum?

Correct Answer: A

Rationale: A firm fundus 3 finger widths below the umbilicus by day 3 postpartum indicates normal uterine involution, as the uterus shrinks progressively after delivery.

Question 2 of 5

The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:

Correct Answer: B

Rationale: Hypersomnolence is an expected side effect of magnesium sulfate due to its central nervous system depressant effects.

Question 3 of 5

The nurse is doing bowel and bladder retraining for the client with paraplegia. Which of the following is not a factor for the nurse to consider?

Correct Answer: D

Rationale: Sexual function is not directly related to bowel and bladder retraining, unlike diet, mobility, and fluid intake.

Question 4 of 5

The nurse is assessing a newborn 24 hours after birth. Which of the following findings would require further evaluation?

Correct Answer: C

Rationale: milia are normal, but persistent or widespread milia may indicate other issues; other findings are within normal limits for a newborn

Question 5 of 5

A nurse is giving instructions to parents of a child who had a tonsillectomy. Which instruction is the most important?

Correct Answer: C

Rationale: Avoiding straws prevents suction that could dislodge clots and cause bleeding, a critical post-tonsillectomy precaution.

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