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Questions 149

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Question 1 of 5

Which of the following assessment findings would indicate to the nurse the need for more sedation in a client who is withdrawing from alcohol dependence?

Correct Answer: A

Rationale: indication that the client is approaching delirium tremens, which can be avoided with additional sedation

Question 2 of 5

The nurse is auscultating a client's breath sounds. Low-pitched grating and rubbing are noted on inhalation and exhalation. What will the nurse chart under assessment findings?

Correct Answer: C

Rationale: Low-pitched grating/rubbing sounds indicate a pleural friction rub, often due to pleural inflammation.

Question 3 of 5

The nurse is caring for a client who is postoperative day 1 following a mastectomy. The client refuses to look at the surgical site or participate in wound care teaching. Which of the following actions by the nurse is MOST appropriate?

Correct Answer: A

Rationale: encouraging the client to express feelings promotes coping and addresses potential body image concerns

Question 4 of 5

A client with alcoholism has been instructed to increase his intake of thiamine. The nurse knows the client understands the instructions when he selects which food?

Correct Answer: D

Rationale: Sliced pork is a rich source of thiamine (vitamin B1), which is critical for preventing Wernicke's encephalopathy in clients with alcoholism.

Question 5 of 5

The client is scheduled to have an intravenous cholangiogram. Before the procedure, the nurse should assess the patient for:

Correct Answer: A

Rationale: Iodinated contrast used in cholangiograms can cause reactions in patients with shellfish or iodine allergies due to potential cross-reactivity.

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