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NEW QUESTION 121
A physician's order reads: Administer furosemide oral solution 0.5 mL stat. The furosemide bottle dosage is 10 mg/mL. What dosage of furosemide should the nurse give to this infant?
- A. 5 mg
- B. 0.05 mg
- C. 20 mg
- D. 0.5 mg
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) 1 mg = 0.1 mL, then 0.5 mL X= 55 mg. (B) Thisanswer is a miscalculation. (C) This answer is a miscalculation. (D) This answer is a miscalculation.
NEW QUESTION 122
When teaching a sex education class, the nurse identifies the most common STDs in the United States as:
- A. Chlamydia
- B. Gonorrhea
- C. Herpes genitalis
- D. Syphilis
Answer: A
Explanation:
(A) Chlamydia trachomatis infection is the most common STD in the United States. The Centers for Disease Control and Prevention recommend screening of all high-risk women, such as adolescents and women with multiple sex partners. (B) Herpes simplex genitalia is estimated to be found in 5-20 million people in the United States and is rising in occurrence yearly. (C) Syphilis is a chronic infection caused by Treponema pallidum. Over the last several years the number of people infected has begun to increase. (D) Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrhoeae. Although gonorrhea is common, chlamydia is still the most common STD.
NEW QUESTION 123
A client's congestive heart failure has been treated, and he will soon be discharged. Discharge teaching should include instruction to call the physician if he notices a 2-lb weight gain in a 24-hour period.
Increased weight gain may indicate:
- A. Development of diabetes insipidus
- B. A diet too high in calories and saturated fat
- C. Decreasing cardiac output
- D. Decreasing renal function
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Increased calories may result in weight gain, but there is no indication in this question that this man's diet has changed in a way that would result in increased calories. (B) Decreasing cardiac output stimulates the renin-angiotensin-aldosterone cycle and results in fluid retention, which is reflected by weight gain. (C) Decreasing renal function may result in fluid retention, but this question gives no indication that this man has any renal problems. (D) Profound diuresis occurs with diabetes insipidus, which results in weight loss.
NEW QUESTION 124
A 29-year-old client is admitted for a hysterectomy. She has repeatedly told the nurses that she is worried about having this surgery, has not slept well lately, and is afraid that her husband will not find her desirable after the surgery. Shortly into the preoperative teaching, she complains of a tightness in her chest, a feeling of suffocation, lightheadedness, and tingling in her hands. Her respirations are rapid and deep. Assessment reveals that the client is:
- A. Suffering from complete upper airway obstruction
- B. Hyperventilating
- C. Wanting attention from the nurses
- D. Having a heart attack
Answer: B
Explanation:
Explanation
(A) Classic symptoms of a heart attack include heaviness or squeezing pain in the chest, pain spreading to the jaw, neck, and arm. Nausea and vomiting, sweating, and shortness of breath may be present. The client does not exhibit these symptoms. (B) Clients suffering from anxiety or fear prior to surgical procedures may develop hyperventilation. This client is not seeking attention. (C) Symptoms of complete airway obstruction include not being able to speak, and no airflow between the nose and mouth. Breath sounds are absent. (D) Tightness in the chest; a feeling of suffocation; lightheadedness; tingling in the hands; and rapid, deep respirations are signs and symptoms of hyperventilation. This is almost always a manifestation of anxiety.
NEW QUESTION 125
A type I diabetic client delivers a male newborn. The newborn is 45 minutes old. What is the primary nursing goal in the nursery during the first hours for this newborn?
- A. Monitor intake and output
- B. Bonding
- C. Maintain normal blood sugar
- D. Maintain normal nutrition
Answer: C
Explanation:
Explanation
(A) Bonding is necessary but would not be the priority with this newborn in the nursery. (B) The infant will be at risk for hypoglycemia because of excess insulin production. (C) Normal nutrition is a goal for all newborns.
(D) Monitoring intake and output is necessary but is not the most critical nursing goal.
NEW QUESTION 126
Iron dextran (Imferon) is a parenteral iron preparation.
The nurse should know that it:
- A. Is also called intrinsic factor
- B. Must be given in the abdomen
- C. Should be given SC
- D. Requires use of the Z-track method
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Intrinsic factor is needed to absorb vitamin B12.(B) Iron dextran is given parenterally, but Z-track in a large muscle. (C) A Ztrack method of injection is required to prevent staining and irritation of the tissue. (D) An SC injection is not deep enough and may cause subcutaneous fat abscess formation.
NEW QUESTION 127
A schizophrenic client has made sexual overtures toward her physician on numerous occasions. During lunch, the client tells the nurse, "My doctor is in love with me and wants to marry me." This client is using which of the following defense mechanisms?
- A. Displacement
- B. Suppression
- C. Projection
- D. Reaction formation
Answer: C
Explanation:
Explanation
(A) Displacement involves transferring feelings to a more acceptable object. (B) Projection involves attributing one's thoughts or feelings to another person. (C) Reaction formation involves transforming an unacceptable impulse into the opposite behavior. (D) Suppression involves the intentional exclusion of unpleasant thoughts or experiences.
NEW QUESTION 128
A client presents to the emergency room with cyanosis, coughing, tachypnea, and tachycardia. She has a history of asthma. Arterial blood gas values are pH 7.28, PaO2 54, PaCO2 60, and HCO3 24. The nursing assessment of arterial blood gases indicate the presence of:
- A. Metabolic acidosis
- B. Respiratory alkalosis
- C. Respiratory acidosis
- D. Metabolic alkalosis
Answer: C
Explanation:
(A) Respiratory alkalosis is determined by elevated pH and low PaCO2. (B) Respiratory acidosis is determined by low pH and elevated PaCO2. (C) Metabolic alkalosis is determined by elevated pH and HCO3. (D) Metabolic acidosis is determined by low pH and HCO3.
NEW QUESTION 129
The nurse is admitting a client with folic acid deficiency anemia. Which of the following questions is most important for the nurse to ask the client?
- A. "Do you take aspirin on a regular basis?"
- B. "Have your stools been normal?"
- C. "Do you drink alcohol on a regular basis?"
- D. "Do you eat red meat?"
Answer: C
Explanation:
Explanation
(A) Aspirin does not affect folic acid absorption. (B) Folic acid deficiency is strongly associated with alcohol abuse. (C) Because folic acid is a coenzyme for single carbon transfer purines, calves liver or other purines are the meat sources. (D) Folic acid does not affect stool character.
NEW QUESTION 130
The mother of a child taking phenytoin will need to plan appropriate mouth care and gingival stimulation.
When tooth-brushing is contraindicated, the next most effective cleansing and gingival stimulation technique would be:
- A. Rinsing with hydrogen peroxide
- B. Using a water pik
- C. Rinsing with water
- D. Rinsing with baking soda
Answer: B
Explanation:
Explanation
(A) This technique provides effective rinsing and gingival stimulation. (B) This technique does not provide gingival stimulation. (C) This technique provides effective rinsing but not gingival stimulation. Using peroxide is not pleasant for the child. (D) This technique provides effective rinsing but not gingival stimulation.
NEW QUESTION 131
A 47-year-old male client is admitted for colon surgery. Intravenous antibiotics are begun 2 hours prior to surgery. He has no known infection. The rationale for giving antibiotics prior to surgery is to:
- A. Reduce the risk of wound infection from anaerobic bacteria
- B. Reduce the risk of intraoperative fever
- C. Provide cathartic action within the colon
- D. Relieve the client's concern regarding possible infection
Answer: A
Explanation:
Section: Questions Set G
Explanation:
(A) Cathartic drugs promote evacuation of intestinal contents. (B) The client undergoing intestinal surgery is at increased risk for infection from large numbers of anaerobic bacteria that inhabit the intestines. Administering antibiotics prophylactically can reduce the client's risk for infection. (C) Antibiotics are indicated in the treatment of infections and have no effect on emotions. (D) Antipyretics are useful in the treatment of elevated temperatures. Antibiotics would have an effect on infection, which causes temperature elevation, but would not directly affect such an elevation.
NEW QUESTION 132
A client is in active labor and has been admitted to the labor and delivery unit. The RN has just done a sterile vaginal exam and determines that the client is dilated 5 cm, effaced 85%, and the fetus's head is at
0 station. She asks if she could have a lumbar epidural now. The epidural is started, and the anesthetic agent used is bupivacaine (Marcaine). After the client has received her lumbar epidural, it is important for the RN to monitor her for which of the following side effects:
- A. Hypotension
- B. Hyperglycemia
- C. Hypoglycemia
- D. Hypertension
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) The medication bupivacaine will cause vasodilation in the vascular system, and this does not result in elevation of the ma-ternal blood pressure. (B) The medication bupivacaine will cause vasodilation in the vascular system, and this will result in lowering the maternal blood pressure. (C) Bupivacaine does not interfere with the functioning of the endocrine system. (D) Bupivacaine does not interfere with the functioning of the endocrine system.
NEW QUESTION 133
A female client presents to the obstetric-gynecology clinic for a pregnancy test, the result which turns out to be positive. Her last menstrual period began December 10, 1993. Using Nägele's rule, the nurse estimates her date of delivery to be:
- A. September 3, 1994
- B. September 10, 1994
- C. August 17, 1994
- D. September 17, 1994
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) According to Nägele's rule, the estimated date of delivery is calculated by adding 7 days to the date of the first day of the normal menstrual period (December 10 + 7 days = December 17), and then by counting back 3 months (December 17 -3 mo = September 17). (B, C, D) These answers are incorrect.
NEW QUESTION 134
Which of the following changes in blood pressure readings should be of greatest concern to the nurse when assessing a prenatal client?
- A. 150/96 to 160/104
- B. 130/88 to 144/92
- C. 118/70 to 130/88
- D. 136/90 to 148/100
Answer: C
Explanation:
Explanation
(A, B, C) The individual's systolic and diastolic changes are more significant than the relatively high initial blood pressure readings. (D) The systolic pressure went up 12 mm Hg and the diastolic pressure 18 mm Hg.
This is a more significant rise than the increases in A-C choices, and client should receive more frequent evaluations and care.
NEW QUESTION 135
The pediatrician has diagnosed tinea capitis in an 8- year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?
- A. May discontinue medication when the child experiences symptomatic relief.
- B. Discontinue drug therapy if food tastes funny.
- C. Administer oral griseofulvin on an empty stomach for best results.
- D. Observe for headaches, dizziness, and anorexia.
Answer: D
Explanation:
(A) Giving the drug with or after meals may allay gastrointestinal discomfort. Giving the drug with a fatty meal (ice cream or milk) increases absorption rate. (B) Griseofulvin may alter taste sensations and thereby decrease the appetite. Monitoring of food intake is important, and inadequate nutrient intake should be reported to the physician. (C) The child may experience symptomatic relief after 48-96 hours of therapy. It is important to stress continuing the drug therapy to prevent relapse (usually about 6 weeks). (D) The incidence of side effects is low; however, headaches are common. Nausea, vomiting, diarrhea, and anorexia may occur. Dizziness, although uncommon, should be reported to the physician.
NEW QUESTION 136
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