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exam 2025
A client who has a diagnosis of complete placenta previa is
admitted to the labor and delivery suite at 36 weeks gestation
with contractions 5 min in frequency and 1 min in duration.
Which of the following actions should the nurse take?
A. Rupture the amniotic sac
B. Medicate the client for pain
C. Prepare the client for a cesarean section
D. Perform a vaginal exam
,Prepare the client for a cesarean section
177. A nurse enters a client's room and finds the client lying on
the floor in a puddle of water. Which of the following statements
should the nurse document in an incident report?
A. Client fell out of bed because an assistive personnel left the
rails of the bed down
B. Client's roommate thinks the client is confused and fell when
getting out of bed
C. Client appears to have slipped in water but reports no injuries
D. Client found lying on the floor near the bedside table
Client found lying on the floor near the bedside table
178. A charge nurse on a pediatric unit is making assignments
for a float nurse from the medical unit. Which of the following
clients is appropriate to assign to the float nurse?
,A. A 10-year-old client who has pneumonia and is receiving
respiratory treatments
B. A 4-year-old client who has a Wilms tumor and is receiving
chemotherapy
C. An 8-month-old client who is scheduled for a surgical repair
of a ventricular septal defect tomorrow
D. A 14-year-old client who is scheduled for discharge today
following placement of a Herrington rod
A 10-year-old client who has pneumonia and is receiving
respiratory treatments
179. A nurse is preparing to administer vancomycin to a client
who has an infected wound. The nurse should plan to monitor
for which of the following adverse reactions?
A. Hepatotoxicity
B. Ototoxicity
C. Hypercalcemia
, D. Hypertension
Ototoxicity
180. A nurse is assessing an infant who has water intoxication.
Which of the following findings should the nurse expect?
A. Generalized edema
B. Elevated urine specific gravity
C. Thready pulse
D. Increased hematocrit
Thready pulse