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,The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36
weeks of gestation. During the measurement the client begins to feel lightheaded. On the basis of
knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of
the lightheadedness?
1.A full bladder
2.Emotional instability
3.Insufficient iron intake
4.Compression of the vena cava - correct ans:4.Compression of the vena cava.
Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome
late in pregnancy. Having the woman turn onto her left side or elevating the left buttock during fundal
height measurement will prevent or correct the problem. The remaining options are unrelated to this
syndrome.
The nursing student is writing a plan of care for a child who presents with an acute head injury. The
nursing instructor reviews the plan of care and praises the student for identifying which assessment as a
priority?
1.
Inspecting the scalp
2.
Pupillary assessment
3.
Airway and breathing
4.
Palpating the child's head - correct ans:3.Airway and breathing.
The first step in the emergency treatment of child with head injury includes the ABCs-airway, breathing,
and circulation-assessments. The other assessments are included when evaluating a head injury, but the
priority is ABC.
A client is suspected of having systemic lupus erythematosus (SLE). On reviewing the client's record, the
nurse should expect to note documentation of which characteristic sign of SLE?
1.Fever
2.Fatigue
3.Skin lesions
, 4.Elevated red blood cell count - correct ans:3.Skin lesions.
Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that
can cause major body organs and systems to fail. The major skin manifestation of SLE is a dry, scaly,
raised rash on the face known as the butterfly rash. Fever and fatigue may occur before and during
exacerbation, but these signs and symptoms are vague. Anemia is most likely to occur in SLE.
The nurse is caring for a child with a diagnosis of neutropenia. Which nursing interventions are most
appropriate for a child placed in protective isolation for neutropenia? Select all that apply.
1.
Place the child on a low-bacteria diet.
2.
Change dressings using sterile technique.
3.
Put flowers in a vase with water before placing in the room.
4.
Peel fruits and vegetables before allowing the child to eat them.
5.
Allow individuals who are ill to visit as long as they wear a mask. - correct ans:1.Place the child on a low-
bacteria diet.
For the hospitalized neutropenic child, flowers or plants should not be kept in the room because
standing water and damp soil harbor Aspergillusand Pseudomonas species, to which these children are
very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be
avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are
always changed using sterile technique. Individuals who are ill are not allowed to visit the client.
The nurse is reviewing the laboratory test results for a client who takes 325 mg of acetylsalicylic acid, or
aspirin, daily and has been having frequent nosebleed episodes. What blood level should the nurse
review?
1.Hemoglobin (Hgb)
2.Prothrombin time (PT)
3.Red blood cell (RBC) level
4.Partial thromboplastin time (PTT) - correct ans:2.Prothrombin time (PT).
Fundamentals NEWEST AND LATEST
EXAM VERSION With Expected real
and comprehensive Questions and
Revised Correct Answers Guarantee
Pass A+
Professional Academic Assistance Services
Services Offered
Proctored Exam Assistance
Online Class Management (Full Course Support)
Exam Preparation & Study Materials
Assignments and Coursework Support
Essays and Research Papers
Discussion Posts and Replies
,The nurse is performing a measurement of fundal height in a client whose pregnancy has reached 36
weeks of gestation. During the measurement the client begins to feel lightheaded. On the basis of
knowledge of the physiological changes of pregnancy, the nurse understands that which is the cause of
the lightheadedness?
1.A full bladder
2.Emotional instability
3.Insufficient iron intake
4.Compression of the vena cava - correct ans:4.Compression of the vena cava.
Compression of the inferior vena cava and aorta by the uterus may cause supine hypotension syndrome
late in pregnancy. Having the woman turn onto her left side or elevating the left buttock during fundal
height measurement will prevent or correct the problem. The remaining options are unrelated to this
syndrome.
The nursing student is writing a plan of care for a child who presents with an acute head injury. The
nursing instructor reviews the plan of care and praises the student for identifying which assessment as a
priority?
1.
Inspecting the scalp
2.
Pupillary assessment
3.
Airway and breathing
4.
Palpating the child's head - correct ans:3.Airway and breathing.
The first step in the emergency treatment of child with head injury includes the ABCs-airway, breathing,
and circulation-assessments. The other assessments are included when evaluating a head injury, but the
priority is ABC.
A client is suspected of having systemic lupus erythematosus (SLE). On reviewing the client's record, the
nurse should expect to note documentation of which characteristic sign of SLE?
1.Fever
2.Fatigue
3.Skin lesions
, 4.Elevated red blood cell count - correct ans:3.Skin lesions.
Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that
can cause major body organs and systems to fail. The major skin manifestation of SLE is a dry, scaly,
raised rash on the face known as the butterfly rash. Fever and fatigue may occur before and during
exacerbation, but these signs and symptoms are vague. Anemia is most likely to occur in SLE.
The nurse is caring for a child with a diagnosis of neutropenia. Which nursing interventions are most
appropriate for a child placed in protective isolation for neutropenia? Select all that apply.
1.
Place the child on a low-bacteria diet.
2.
Change dressings using sterile technique.
3.
Put flowers in a vase with water before placing in the room.
4.
Peel fruits and vegetables before allowing the child to eat them.
5.
Allow individuals who are ill to visit as long as they wear a mask. - correct ans:1.Place the child on a low-
bacteria diet.
For the hospitalized neutropenic child, flowers or plants should not be kept in the room because
standing water and damp soil harbor Aspergillusand Pseudomonas species, to which these children are
very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be
avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are
always changed using sterile technique. Individuals who are ill are not allowed to visit the client.
The nurse is reviewing the laboratory test results for a client who takes 325 mg of acetylsalicylic acid, or
aspirin, daily and has been having frequent nosebleed episodes. What blood level should the nurse
review?
1.Hemoglobin (Hgb)
2.Prothrombin time (PT)
3.Red blood cell (RBC) level
4.Partial thromboplastin time (PTT) - correct ans:2.Prothrombin time (PT).
