QUESTIONS WITH FULL SOLUTION GRADED
A+
◉ While caring for a toddler with croup, which initial sign of croup
requires the nurse's immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions. Answer: A) Respiratory rate of
42
◉ 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. Answer: 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.". Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer:
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. Answer: 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. Answer: 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