Answers 2024 Latest Update
A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial assessment,
the nurse would anticipate which of the following assessment findings?
A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions A) Lethargy
The emergency room nurse admits a child who experienced a seizure at school. The father
comments that this is the first occurrence, and denies any family history of epilepsy. What is the
best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures." B) "The seizure may or may not
mean your child has epilepsy."
,Alcohol and drug abuse impairs judgment and increases risk taking behavior. What nursing
diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem A) Risk for injury
Which these findings would the nurse more closely associate with anemia in a 10 month-old
infant?
A) Hemoglobin level of 12 g/dI
B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160 B) Pale mucosa of the eyelids and lips
The nurse is caring for a client in hypertensive crisis in an intensive care unit. The priority
assessment in the first hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
,D) Pupil responses D) Pupil responses
Which of these clients who are all in the terminal stage of cancer is least appropriate to suggest
the use of patient controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on the hands
D) A preschooler with intermittent episodes of alertness D) A preschooler with
intermittent episodes of alertness
The nurse is about to assess a 6 month-old child with nonorganic failure-to thrive (NOFTT).
Upon entering the room, the nurse would expect the baby to be
A) Irritable and "colicky" with no attempts to pull to standing
B) Alert, laughing and playing with a rattle, sitting with support
C) Skin color dusky with poor skin turgor over abdomen
D) Pale, thin arms and legs, uninterested in surroundings D) Pale, thin arms and legs,
uninterested in surroundings
, As the nurse is speaking with a group of teens which of these side effects of chemotherapy for
cancer would the nurse expect this group to be more interested in during the discussion?
A) Mouth sores
B) Fatigue
C) Diarrhea
D) Hair loss D) Hair loss
While caring for a client who was admitted with myocardial infarction (MI) 2 days ago, the
nurse notes today's temperature is 101.1 degrees Fahrenheit (38.5 degreesCelsius). The
appropriate nursing intervention is to
A) Call the health care provider immediately
B) Administer acetaminophen as ordered as this is normal at this time
C) Send blood, urine and sputum for culture
D) Increase the client's fluid intake B) Administer acetaminophen as ordered as this is
normal at this time
A client is admitted for first and second degree burns on the face, neck, anterior chest and hands.
The nurse's priority should be
A) Cover the areas with dry sterile dressings