Answers | Graded A+
1. Why is checking vital signs considered the priority intervention for a client
with diabetes insipidus?
It helps determine the amount of urine produced.
Checking vital signs helps assess the client's hemodynamic stability
and potential complications.
It allows for monitoring of the client's weight changes.
It provides information about the client's fluid intake.
2. A client in sickle crisis asks the nurse about food choices. Which food source
should the nurse recommend to the client?
Pancakes with syrup
Orange popsicle
Hot chocolate
Hamburger with French fries
3. Which topic will the nurse include when teaching a client who has a new
diagnosis of polycythemia vera?
Avoidance of any aspirin use
Purpose for iron supplements
Self-administration of erythropoietin
Need for high fluid intake
4. The physician orders lisinopril (Zentril) and furosemide (lasix) to be
administered concomitantly to the clientwith hypertention. The nurse should:
, Contact the pharmacy.
Question the order.
Administer them separately.
Administer the medication.
5. If the calcium level is found to be low in a patient post-total thyroidectomy,
what would be the most appropriate nursing intervention?
Increase the patient's fluid intake.
Monitor the patient for signs of infection.
Initiate a blood transfusion.
Administer calcium supplements as prescribed.
6. A patient with hemophilia experiences a nosebleed during a routine check-
up. After pinching the soft lower part of the nose for 5 minutes, the bleeding
continues. What should the nurse do next?
Apply heat to the nose to promote blood flow.
Continue pinching the nose for another 10 minutes without
reassessment.
Administer a clotting factor immediately.
Reassess the patient and consider additional interventions such as
packing the nares or contacting a physician.
7. The nurse is caring for a newly admitted 25-year-old male who is in sickle cell
crisis. Which of the following interventions should be of highest priority for
this client?
Placing the client in high Fowler's position
Administering pain medication prn
, Encouraging fluid intake of at least 200 mL/hour
Obtaining hourly blood pressure readings
8. What is the priority nursing diagnosis for a client newly diagnosed with
autoimmune thrombocytopenic purpura?
Impaired Skin Integrity
Risk for Injury
Impaired Gas Exchange
Acute Pain
9. A patient with angina is found to have stored their nitroglycerine in a clear
container. What potential issue could arise from this storage method?
Increased risk of contamination from air
Increased risk of medication overdose
Decreased effectiveness of the medication due to light exposure
Improper dosage due to container size
10. Why is examining the tongue an important part of the physical assessment
for a client with vitamin B12 deficiency?
The tongue's color indicates blood pressure levels.
The tongue may show signs of glossitis, which is common in vitamin
B12 deficiency.
The tongue is assessed for signs of infection.
The tongue is unrelated to vitamin B12 levels.
, 11. The nurse is contributing to a parent education program about sickle cell
anemia. Which of the following information should the nurse recommend
including?
Apply cold to painful areas
Increase activity during exacerbations
Avoid high altitudes
Limit fluid intake
12. Why might sexual dysfunction be considered a priority diagnosis for a
patient receiving radiation therapy for Hodgkin's lymphoma?
Anticipatory grieving is only relevant in terminal cases.
Fatigue is the most common side effect of chemotherapy.
Tissue integrity issues are primarily related to surgical interventions.
Sexual dysfunction can significantly impact the patient's quality of
life and relationships.
13. If a patient with a history of Hodgkin's disease presents with symptoms of
fatigue and frequent infections, what should the nurse prioritize in the
assessment?
Family history of diabetes
Current medication list
History of radiation therapy
Dietary habits
14. What is a common clinical manifestation of vitamin B12 deficiency anemia?
Edema