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Questions 163

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Question 1 of 5

While sitting at the nurse's station, the nurse observes that a client uses a tissue to pick up magazines and change channels on the television. There has been no such behavior in the past. The nurse should:

Correct Answer: A

Rationale: Talking with the client assesses potential obsessive-compulsive behavior or anxiety. Gloves or removing tissues may escalate distress. Attention-seeking is an assumption without evidence.

Question 2 of 5

The nurse has just received the shift report. Which one of the following clients should be seen first?

Correct Answer: D

Rationale: Answer D is correct. There is nothing in answer A that indicates the client is unstable. Answer B is a good choice, but the client three days post-fracture may have a slight temperature, so he should be seen second. Answer C is also a good choice, but if the infant with dehydration is stable, the 8-week-old with respiratory distress (sub-sternal retractions and low oxygen saturation) is the most critical and should be seen first.

Question 3 of 5

The nurse would teach a client with Raynaud's phenomenon that, after smoking cessation, it is most important to

Correct Answer: A

Rationale: Avoid caffeine. Caffeine can trigger vasoconstriction, exacerbating Raynaud's phenomenon symptoms, making it a priority after smoking cessation.

Question 4 of 5

The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn?

Correct Answer: C

Rationale: Swaddling with hips flexed and abducted promotes healthy hip development and reduces dysplasia risk. Narrow carriers and straight-leg swings increase risk, and double diapering is outdated and ineffective.

Question 5 of 5

A client is scheduled for a myelogram. Which of the following medications orders should be questioned?

Correct Answer: B

Rationale: Ibuprofen (Motrin) has anticoagulant properties, increasing bleeding risk during a myelogram, a procedure involving spinal puncture. Other medications are safer.

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