NCLEX-RN Quiz Part 8 (376-450)

NO.376 After 7 hours in restraints and a total of 30-mg haloperidol in divided doses, a client complains of stiffness in his neck and his tongue "pulling to one side." These extrapyramidal symptoms (EPS) will most likely be relieved by the administration of:

A.            Lorazepam (Ativan)

B.            Benztropine (Cogentin)

C.            Thiothixene (Navane)

D.            Flurazepan (Dalmane)

NO.377 A client is being admitted to the labor and delivery unit. She has had previous admissions for "false labor." Which clinical manifestation would be most indicative of true labor?

A.            Increased bloody show

B.            Progressive dilatation and effacement of the cervix

C.            Uterine contractions

D.            Decreased discomfort with ambulation

NO.378 In healthcare settings, nurses must be familiar with primary, secondary, and tertiary levels of care. As a nurse in the community, which of the following interventions might be a primary prevention strategy?

A.            Crisis intervention with an intoxicated teenager whose mother just committed suicide

B.            Referring a client who has been on a detoxification unit to a rehabilitation center

C.            Teaching fifth-grade children the harmful effects of substance abuse

D.            Counseling a client with post-traumatic stress disorder

NO.379 A 15-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia. Which of the following would be included in educating the mother and child as part of discharge planning?

A.            Give oral iron medication every day.

B.            Have the child's blood pressure monitored every week.

C.            Know the signs and symptoms of iron overload.

D.            Keep exercise at a minimum to reduce stress.

NO.380 What is the most effective method to identify early breast cancer lumps?

A.            Mammograms every 3 years

B.            Yearly checkups performed by physician

C.            Ultrasounds every 3 years

D.            Monthly breast self-examination

NO.381 An IDDM client's condition stabilizes. He begins to receive a daily injection of NPH insulin at 6:30 AM. The nurse can most likely expect a hypoglycemic reaction to occur that same day at:

A. 8:30 AM-10:30 AM

B. 2:30 PM-4:30 PM

C. 7:30 PM-9:30 PM

D. 10:30 PM-11:30 PM

NO.382 A 50-year-old depressed client has recently lost his job. He has been reluctant to leave his hospital room. Nursing care would include:

A.            Forcing the client to attend all unit activities

B.            Encouraging the client to discuss why he is so sad

C.            Monitoring elimination patterns

D.            Providing sensory stimulation

NO.383 Discharge teaching was effective if the parents of a child with atopic dermatitis could state the importance of:

A.            Maintaining a high-humidified environment

B.            Furry, soft stuffed animals for play

C.            Showering 3-4 times a day

D.            Wrapping hands in soft cotton gloves

 NO.384 A client has been admitted to the labor and delivery unit in active labor. After assessing her, the RN notes that the client's fetus position is left occipital posterior. Which of the following statements best describes what this means to the labor process:

A.            Decreases the overall time of the labor process

B.            Prolongs the client's first stage of labor

C.            Decreases the time of the client's first stage of labor

D.            Prolongs the client's third stage of labor

NO.385 On morning rounds, the nurse found a manic-depressive client who is taking lithium in a confused mental state, vomiting, twitching, and exhibiting a coarse hand tremor. Which one of the following nursing actions is essential at this time?

A.            Administer her next dosage of lithium, and then call the physician.

B.            Withhold her lithium, and report her symptoms to the physician.

C.            Place her on NPO to decrease the excretion of lithium from her body, and call the physician.

D.            Contact the lab and request a lithium level in 30 minutes, and call the physician.

NO.386 A female client comes for her second prenatal visit. The nurse-midwife tells her, "Your blood tests reveal that you do not show immunity to the German measles." Which notation will the nurseinclude in her plan of care for the client? "Will need . . .

A.            Rh-immune globulin at the next visit"

B.            Rh-immune globulin within 3 days of delivery"

C.            Rubella vaccine at the next visit"

D.            Rubella vaccine after delivery on the day of discharge"

NO.387 A 70-year-old female client is admitted to the medical intensive care unit with a diagnosis of cerebrovascular accident (CVA). She is semicomatose, responding to pain and change in position. She is unable to speak or cough. In planning her nursing care for the first 24 hours following a CVA, which nursing diagnosis should receive the highest priority?

A.            Ineffective airway clearance related to immobility, ineffective cough, and decreased level of consciousness

B.            Altered cerebral tissue perfusion related to pathophysiological changes that decrease blood flow

C.            Potential for injury related to impaired mobility and seizures

D.            Impaired verbal communication related to aphasia

NO.388 A 72-year-old male client had the Foley catheter that was inserted during the transurethral resection of his prostate removed today. He is concerned about the urinary incontinence he is having since removal of the Foley catheter. The nurse explains that:

A.            He should not be concerned about it because it will resolve quickly

B.            This is usually temporary

C.            The nurse will keep him dry, and he should notify the nurse when this happens

D.            This is related to the bladder spasms and will soon stop

NO.389 When a client with pancreatitis is discharged, the nurse needs to teach him how to prevent another occurrence of acute pancreatitis. Which of the following statements would indicate he has an understanding of his disease?

A.            "I will not eat any raw or uncooked vegetables."

B.            "I will limit my alcohol to one cocktail per day."

C.            "I will look into attending Alcoholics Anonymous meetings."

D.            "I will report any changes in bowel movements to my doctor."

NO.390 A pregnant client continues to visit the clinic regularly during her pregnancy. During one of her visits while lying supine on the examining table, she tells the RN that she is becoming light- headed. The RN notices that the client has pallor in her face and is perspiring profusely.

The first intervention the RN should initiate is to:

A.            Place the examining table in the Trendelenburg position

B.            Assess the client to see if she is having vaginal bleeding

C.            Obtain the client's vital signs immediately

D.            Help the client to a sitting position

NO.391 A client is having a pneumonectomy done today, and the nurse is planning her postoperative care. Nursing interventions for a postoperative left pneumonectomy would include:

A.            Monitoring the chest tubes

B.            Positioning the client on the right side

 C.           Positioning the client in semi-Fowler position with a pillow under the shoulder and back

D.            Monitoring the right lung for an increase in rales

NO.392 Children often experience visual impairments. Refractive errors affect the child's visual activity. The main refractive error seen in children is myopia. The nurse explains to the child's parents that myopia may also be described as:

A.            Cataracts

B.            Farsightedness

C.            Nearsightedness

D.            Lazy eye

NO.393 One of the most dramatic and serious complications associated with bacterial meningitis is Waterhouse- Friderichsen syndrome, which is:

A.            Peripheral circulatory collapse

B.            Syndrome of inappropriate antiduretic hormone

C.            Cerebral edema resulting in hydrocephalus

D.            Auditory nerve damage resulting in permanent hearing loss

NO.394 When inspecting a cardiovascular client, the nurse notes that he needs to sit upright to breathe. This behavior is most indicative of:

A.            Pericarditis

B.            Anxiety

C.            Congestive heart failure

D.            Angina

NO.395 Several months after antibiotic therapy, a child is readmitted to the hospital with an exacerbation of osteomyelitis, which is now in the chronic stage. The mother appears anxious and asks what she could have done to prevent the exacerbation. The nurse's response is based on the knowledge that chronic osteomyelitis:

A.            Is caused by poor physical conditions or poor nutrition

B.            Often results from unhygienic conditions or an unclean environment

C.            Is directly related to sluggish circulation in the affected limb

D.            May develop from sinuses in the involved bone that retain infectious material

NO.396 Blood work reveals the following lab values for a client who has been diagnosed with anorexia nervosa: hemoglobin 9.6 g/dL, hemocrit 27%, potassium 2.7 mEq/L, sodium 126 mEq/L. The greatest danger to her at this time is:

A.            Hypoglycemia from low-carbohydrate intake

B.            Possible cardiac dysrhythmias secondary to hypokalemia

C.            Dehydration from vomiting

D.            Anoxia secondary to anemia

NO.397 A client is pregnant for the fourth time and has had three normal vaginal deliveries. She is in active labor and fully dilated. Suddenly she calls, "Nurse, the baby is coming." As the nurse responds to her call, which one of the following observations should the nurse make first?

A.            Inspect the perineum.

B.            Time the contractions.

C.            Prepare a sterile area for delivery.

D.            Auscultate for fetal heart rate (FHR).

NO.398 In working with a manipulative client, which of the following nursing interventions would be most appropriate?

A.            Bargaining with the client as a strategy to control the behavior

B.            Redirecting the client

C.            Providing a consistent set of guidelines and rules

D.            Assigning the client to different staff persons each day

NO.399 The nurse is trying to help a mother understand what is happening with her son who has recently been diagnosed with paranoid schizophrenia. At present, he is experiencing hallucinations and delusions of persecution and suffers from poor hygiene. The nurse can best help her understand her son's condition by which of the following statements?

A.            "Sometimes these symptoms are caused by an overstimulation of a chemical called dopamine in the brain."

 B.           "Has anyone in your family ever had schizophrenia?"

C.            "If your son has a twin, he probably will eventually develop schizophrenia, too."

D.            "Some of his symptoms may be a result of his lack of a strong mother-child bonding relationship."

NO.400 The usual treatment for diabetes insipidus is with IM or SC injection of vasopressin tannate in oil. Nursing care related to the client receiving IM vasopressin tannate would include:

A.            Weigh once a week and report to the physician any weight gain of10 lb.

B.            Limit fluid intake to 500 mL/day.

C.            Store the medication in a refrigerator and allow to stand at room temperature for 30 minutes prior to administration.

D.            Hold the vial under warm water for 10-15 minutes and shake vigorously before drawing medication into the syringe.

NO.401 In an interview for suspected child abuse, the child's mother openly discusses her feelings. She feels her husband is too aggressive in disciplining their child. The child's father states,

"Being a school custodian, I see kids every day that are bad because they did not get enough discipline at home. That will not happen to our child." Based on this remark, the nurse would make the following nursing diagnosis:

A.            Fear related to retaliation by the father

B.            Actual injury related to poor impulse control by the father

C.            Ineffective coping

D.            Altered family process related to physical abuse

NO.402 A female client has been recently diagnosed as bipolar. She has taken lithium for the past several weeks to control mania. What must be included in client education regarding lithium toxicity?

A.            Maintain a normal diet; however, limit salt intake to no more than 3 g/day.

B.            Take lithium between meals to increase absorption.

C.            Withhold lithium if experiencing diarrhea, vomiting, or diaphoresis.

D.            For pain or fever, avoid aspirin or acetaminophen (Tylenol). Nonsteroidal antiinflammatory drugs are preferred.

NO.403 A 56-year-old psychiatric inpatient has had recurring episodes of depression and chronic low self-esteem. She feels that her family does not want her around, experiences a sense of helplessness, and has a negative view of herself. To assist the client in focusing on her strengths and positive traits, a strategy used by the nurse would be to:

A.            Tell the client to attend all structured activities on the unit

B.            Encourage or direct client to attend activities that offer simple methods to attain success

C.            Increase the client's self-esteem by asking that she make all decisions regarding attendance in group activities

D.            Not allow any dependent behaviors by the client because she must learn independence and will have to ask for any assistance from staff

NO.404 The physician recommends immediate hospital admission for a client with PIH. She says to the nurse, "It's not so easy for me to just go right to the hospital like that." After acknowledging her feelings, which of these approaches by the nurse would probably be best?

A.            Stress to the client that her husband would want her to do what is best for her health.

 B.           Explore with the client her perceptions of why she is unable to go to the hospital.

C.            Repeat the physician's reasons for advising immediate hospitalization.

D.            Explain to the client that she is ultimately responsible for her own welfare and that of her baby.

 

NO.405 A male client has asthma and his physician has prescribed beclomethasone (Vanceril) 3 puffs tid in addition to his other medications. After taking his beclomethasone, the client should be instructed to:

A.            Clean his inhaler with warm water and soak it in a 10% bleach solution

B.            Drink a glass of water

C.            Sit and rest

D.            Use his bronchodilator inhaler

NO.406 An obstructing stone in the renal pelvis or upper ureter causes:

A.            Radiating pain into the urethra with labia pain experienced in females or testicular pain in males

B.            Urinary frequency and dysuria

C.            Severe flank and abdominal pain with nausea, vomiting, diaphoresis, and pallor

D.            Dull, aching, back pain

NO.407 A first-trimester primigravida is diagnosed with anemia. The nurse should suspect that this anemia is a result of:

A.            Mother's increased blood volume

B.            Mother's decreased blood volume

C.            Fetal blood volume increase

D.            Increase in iron absorption

NO.408 The nurse is teaching a mother care of her child's spica cast. The mother states that he complains of itching under the edge of the cast. One nonpharmacological technique the nurse might suggest would be:

A.            "Blowing air under the cast using a hair dryer on cool setting often relieves itching."

B.            "Slide a ruler under the cast and scratch the area."

C.            "Guide a towel under and through the cast and move it back and forth to relieve the itch."

D.            "Gently thump on cast to dislodge dried skin that causes the itching."

NO.409 A client is resting comfortably after delivering her first child. When assessing her pulse rate, the nurse would recognize the following finding to be typical:

A.            Thready pulse

B.            Irregular pulse

C.            Tachycardia

D.            Bradycardia:

NO.410 When interviewing parents who are suspected of child abuse, the nurse would use which of the following interview techniques?

A.            Be direct, honest, and attentive.

B.            Approach them in the emergency room as soon as you suspect abuse to "clear the air" right away.

C.            Ask the parents what they could have done differently to prevent this from happening to the child.

D.            After the interview, call child protective services.

NO.411 A pregnant woman at 36 weeks' gestation is followed for PIH and develops proteinuria. To increase protein in her diet, which of the following foods will provide the greatest amount of protein when added to her intake of 100 mL of milk?

A.            Fifty milliliters light cream and 2 tbsp corn syrup

B.            Thirty grams powdered skim milk and 1 egg

C.            One small scoop (90 g) vanilla ice cream and 1 tbsp chocolate syrup

D.            One package vitamin-fortified gelatin drink

NO.412 The nurse teaches a pregnant client that a high-risk symptom occurring at any time during pregnancy that needs to be reported immediately to a healthcare provider is:

A.            Constipation

B.            Urinary frequency

C.            Breast tenderness

 D.           Abdominal pain

NO.413 A 15-year-old female adolescent is frequently breaking the rules of the unit. She has left the unit and was found

smoking in the bathroom and spending a large amount of time in the male ward. Which statement by the nurse would best explain to the teenager why she must follow the rules of the unit?

A.            "It is not easy, but the rules must be followed so that everyone can get a fair chance."

B.            "If you do not follow the rules, you will be transferred to the closed, locked unit."

C.            "You are not being fair to the other clients by getting them involved in your deviant behavior."

D.            "Break the rules, all you want, but don't get caught again!"

NO.414 A 28-year-old woman was admitted to the hospital for a thyroidectomy. Postoperatively she is taken to the postanesthesia care unit for several hours. In preparing for the client's return to her room, which nursing measure best demonstrates the nurse's thorough understanding of possible postthyroidectomy complications?

A.            Dressings are placed at the bedside for dressing changes, which are to be done every 2 hours to best detect postoperative bleeding.

B.            Narcotics are readily available and administered when the client returns to her room to prevent excruciating pain.

C.            A tracheostomy set, O2, and suction are available at the bedside.

D.            The nurse should instruct the client as soon as possible on alternative means of communication.

 

NO.415 A 6-year-old girl is visiting the outpatient clinic because she has a fever and a rash. The doctor diagnoses chickenpox. Her mother asks the nurse how many baby aspirins her daughter can have for fever. The nurse should:

A.            Advise the mother not to give her aspirin

B.            Ask if the client is allergic to aspirin before giving further information

C.            Assess the function of the client's cranial nerve VIII

D.            Check the aspirin bottle label to determine milligrams per tablet

NO.416 A 50-year-old male client is to receive chemotherapy. The physician's orders include antiemetics. When planning his care, the nurse should take into consideration that antiemetics are best administered in the following way:

A.            Give antiemetics when nausea is experienced and continue on a regular schedule for 12-24 hours.

B.            Give antiemetics prior to the client receiving chemotherapy and continue on a regular basis for at least 24-48 hours after chemotherapy.

C.            Give antiemetics one at a time because combinations of antiemetics cause overwhelming side effects.

D.            Give antiemetics intermittently during the entire course of chemotherapy.

NO.417 The nurse practitioner determines that a client is approximately 9 weeks' gestation. During the visit, the practitioner informs the client about symptoms of physical changes that she will experience during her first trimester, such as:

A.            Nausea and vomiting

B.            Quickening

C.            A 6-8 lb weight gain

 D.           Abdominal enlargement

NO.418 A client with severe PIH receiving MgSO4 is placed in a quiet, darkened room. The nurse bases this action on the following understanding:

A.            The client is restless.

B.            The elevated blood pressure causes photophobia.

C.            Noise or bright lights may precipitate a convulsion.

D.            External stimuli are annoying to the client with PIH.

NO.419 A client has consented to have a central venous catheter placed. The best position in which to place the client is the Trendelenburg position. The reason is that the Trendelenburg position:

A.            Allows the physician to visualize the subclavian vein

B.            Reduces the possibility of air embolism

C.            Reduces the possibility of hematoma formation

D.            Makes the procedure more comfortable for the client

NO.420 A newborn infant is exhibiting signs of respiratory distress. Which of the following would the nurse recognize as the earliest clinical sign of respiratory distress?

A.            Cyanosis

B.            Increased respirations

C.            Sternal and subcostal retractions

D.            Decreased respirations

NO.421 A 32-year-old male client is a marketing representative. His job requires him to have a tremendous amount of energy during the day. He frequently uses cocaine to sustain his energy level. Lately he has increased his use of cocaine and even experimented with crack cocaine. Realizing he can no longer continue this destructive behavior, he is seeking treatment for cocaine addiction. In planning nursing care for the client's inpatient stay, which expected outcome is most appropriate?

A.            He will attend four consecutive group educational sessions on substance abuse.

B.            He will name activities that he would most likely be involved in posttreatment.

C.            He will meet with his family in counseling sessions and discuss his feelings.

D.            He will be able to deal with his feelings through participation in group therapy sessions.

NO.422 The physician prescribes amitriptyline (Elavil) for a client. What does the patient need to know about this medication?

A.            Prolonged use of this medication will result in extrapyramidal side effects.

B.            When the medication is effective, he will experience no anxiety.

C.            The medication should relieve his symptoms of depression.

D.            Blood must be drawn weekly to test for toxicity.

NO.423 A registered nurse is trying to determine the appropriate care that she should provide for her obstetrical clients. Which of the following documents is considered the legal standard of practice?

A.            State nursing practice act

B.            AWHONN Standards for the Nursing Care of Women and Newborns

C.            American Nurses' Association Standards of Maternal- Child Health Nursing

D.            International Council of Nurses' Code

NO.424 A 55-year-old woman entered the emergency room by ambulance. Her primary complaint is chest pain. She is receiving O2 via nasal cannula at 2 L/min for dyspnea. Which of the following findings in the client's nursing assessment demand immediate nursing action?

A.            Associated symptoms of indigestion and nausea

B.            Restlessness and apprehensiveness

C.            Inability to tolerate assessment session with the admitting nurse

D.            History of hypertension treated with pharmacological therapy

NO.425 Parents of young children often need anticipatory guidance from the nurse. Parents may have little knowledge regarding growth and development. Which of the following toys and activities would the nurse suggest as appropriate for a toddler?

A.            Cutting, pasting, string beads, music, dolls

B.            Mobiles, rattle, squeeze toys

C.            Pull-toys, large ball, dolls, sand and water play, music

D.            Simple card games, puzzles, bicycle, television

NO.426 A 23-year-old female client is brought to the emergency room by her roommate for repeatedly making superficial cuts on her wrists and experiencing wide mood swings. She is very angry and hostile. Her medical diagnosis is adjustment disorder versus borderline personality disorder. The client comments to the nurse, "Nobody in here seems to really care about the clients. I thought nurses cared about people!" The client is exhibiting the ego defense mechanism:

A.            Reaction formation

B.            Rationalization

C.            Splitting

D.            Sublimation

NO.427 A female client has married recently. A month ago she visited her physician with complaints of burning on urination. She was given a prescription for trimethoprim- sulfamethoxazole (Bactrim) DS bid for 10 days. She was admitted through the emergency room on Saturday evening complaining of flank pain. Her temperature was 104_F. A preliminary urinalysis revealed 31 bacteria along with red and white blood cells in the urine. A preliminary diagnosis of pyelonephritis was made. During a nursing admission assessment, which statement by the client demonstrates a possible cause for pyelonephritis?

A.            "I have not been drinking six to eight glasses of water each day as the nurse had instructed."

B.            "I'm afraid I may have something wrong with my bladder because I have been getting bladder infections frequently since I've been married."

C.            "I took the Bactrim for 6 or 7 days. The burning stopped, so I saved the rest of the medication for the next time."

D.            "I recently had the flu, which could be settling in my kidneys now."

NO.428 Morphine sulfate 4 mg IV push q2h prn for chest pain was ordered for a client in the emergency room with severe chest pain. The nurse administering the morphine sulfate knows which of the following therapeutic actions is related to the morphine sulfate?

A.            Increased level of consciousness

B.            Increased rate and depth of respirations

C.            Increased peripheral vasodilation

D.            Increased perception of pain

NO.429 An 82-year-old former restaurant owner walks to the nursing station and states, "I have to go. The restaurant opens at 11 am." Which response by the nurse is the most appropriate?

A.            "Go back to your room. You do not own a restaurant."

B.            "You are in the hospital now. Calm down."

C.            "You once owned a restaurant. Tell me about it."

D.            "It is snowing outside. The restaurant is closed."

NO.430 A male infant is to be discharged home this morning. Which instruction related to his cordcare should be included in his mother's discharge teaching plan?

A.            Keep the umbilical area moist with Vaseline until the stump falls off.

B.            Keep the umbilical area covered at all times with the diaper.

C.            Clean the umbilical cord with alcohol at each diaper change.

D.            Clean the umbilical cord daily with soap and water during the bath.

NO.431 Iron dextran (Imferon) is a parenteral iron preparation. The nurse should know that it:

A.            Is also called intrinsic factor

B.            Must be given in the abdomen

C.            Requires use of the Z-track method

D.            Should be given SC

NO.432 A client develops complications following a hysterectomy. Blood cultures reveal Pseudomonas aeruginosa.

The nurse expects that the physician would order an appropriate antibiotic to treat P.aeruginosa such as:

A.            Cefoperazone (Cefobid)

B.            Clindamycin (Cleocin)

C.            Dicloxacillin (Dycill)

D.            Erythromycin (Erythrocin)

NO.433 A 74-year-old client seen in the emergency room is exhibiting signs of delirium. His familystates that he has not slept, eaten, or taken fluids for the past 24 hours. The planning of nursing care for a delirious client is based on which of the following premises?

A.            The delirious client is capable of returning to his previous level of functioning.

B.            The delirious client is incapable of returning to his previous level of functioning.

C.            Delirium entails progressive intellectual and behavioral deterioration.

D.            Delirium is an insidious process.

NO.434 A client on the infectious disease unit is discussing transmission of human immunodeficiency virus (HIV).

The nurse would need to provide more client education based on which client statement?

A.            "HIV is a virus transmitted by sexual contact."

B.            "Condoms reduce the transmission of HIV."

C.            "HIV is a virus that is easily transmitted by casual contact."

D.            "HIV can be transmitted to an unborn infant."

NO.435 A 2-month-old infant is receiving IV fluids with a volume control set. The nurse uses this type of tubing because it:

A.            Prevents administration of other drugs

B.            Prevents entry of air into tubing

C.            Prevents inadvertent administration of a large amount of fluids

D.            Prevents phlebitis

NO.436 In addition to changing the mother's position to relieve cord pressure, the nurse may employ the following measure (s) in the event that she observes the cord out of the vagina:

A.            Immediately pour sterile saline on the cord, and repeat this every 15 minutes to prevent drying.

 B.           Cover the cord with a wet sponge.

C.            Apply a cord clamp to the exposed cord, and cover with a sterile towel.

D.            Keep the cord warm and moist by continuous applications of warm, sterile saline compresses.

NO.437 A pregnant client is at the clinic for a third trimester prenatal visit. During this examination, it has been determined that her fetus is in a vertex presentation with the occiput located in her right anterior quadrant. On her chart this would be noted as:

A.            Right occipitoposterior

B.            Right occipitoanterior

C.            Right sacroanterior

D.            LOA

NO.438 A client who is a breast-feeding mother develops mastitis. The clinical signs and symptoms of mastitis include:

A.            Marked engorgement, elevated temperature, chills, and breast pain with an area that is red and hardened

B.            Marked engorgement and breast pain

C.            Elevated temperature and general malaise

D.            Cracked nipple with complaints of soreness

NO.439 A 26-year-old client is admitted to the labor, delivery, recovery, postpartum unit. The nurse completes her assessment and determines the client is in the first stage of labor. The nurse should instruct her:

A.            To hold her breath during contractions

B.            To be flat on her back

C.            Not to push with her contractions

D.            To push before becoming fully dilated

NO.440 In a client with chest trauma, the nurse needs to evaluate mediastinal position. This can best be done by:

A.            Auscultating bilateral breath sounds

B.            Palpating for presence of crepitus

C.            Palpating for trachial deviation

D.            Auscultating heart sounds

NO.441 A 68-year-old man was recently diagnosed with endstage renal disease. He has not yet begun dialysis but is experiencing severe anemia with associated symptoms of dyspnea on exertion and chest pain. Which statement best describes the management of anemia in renal failure?

A.            Hematocrit levels usually remain slightly below normalin clients with renal failure.

B.            Transfusion is often begun as early as possible to prevent complications of anemia such as dyspnea and angina.

C.            Anemia in renal failure is frequently caused by low serum iron and ferritin and corrected by oral iron and ferritin replacement therapy.

D.            The renal secretion of erythropoiesis is decreased. The bone marrow requires erythropoietin to mature red blood cells.

NO.442 A 10-year-old has been diagnosed with acute poststreptococcal glomerulonephritis. The clinical findings were proteinuria, moderately elevated blood pressure, and periorbital edema. Which dietary plan is most appropriate for this client?

A.            Low-protein diet

B.            Low-sodium diet

C.            Increased fluid intake

D.            High-cholesterol diet

NO.443 In performing the initial nursing assessment on a client at the prenatal clinic, the nurse will know that which of the following alterations is abnormal during pregnancy?

A.            Striae gravidarum

B.            Chloasma

C.            Dysuria

D.            Colostrum

NO.444 Which classification of drugs is contraindicated for the client with hypertrophic cardiomyopathy?

A.            Positive inotropes

B.            Vasodilators

C.            Diuretics

 

D.            Antidysrhythmics

NO.445 A client has been diagnosed with congestive heart failure. His fluid intake and output are strictly regulated. For lunch, he drank 8 oz of milk, 4 oz of tea, and 6 oz of coffee. His intake would be recorded as:

A.            500 mL

B.            540 mL

C.            600 mL

D.            655 mL

NO.446 Painless vaginal bleeding in the last trimester may be caused by:

A.            Menstruation

B.            Abruptio placentae

C.            Placenta previa

D.            Polyhydramnios

NO.447 The nurse should know that according to current thinking, the most important prognostic factor for a client with breast cancer is:

A.            Tumor size

B.            Axillary node status

C.            Client's previous history of disease

D.            Client's level of estrogen-progesterone receptor assays

NO.448 The primary reason that an increase in heart rate (100 bpm) detrimental to the client with a myocardial infarction (MI) is that:

A.            Stroke volume and blood pressure will drop proportionately

B.            Systolic ejection time will decrease, thereby decreasing cardiac output

C.            Decreased contractile strength will occur due to decreased filling time

D.            Decreased coronary artery perfusion due to decreased diastolic filling time will occur, which will increase ischemic damage to the myocardium

NO.449 Assessment of a client reveals a 30% loss of preillness weight, lanugo, and cessation of menses for 3 months. Her vital signs are BP 90/50, P 96 bpm, respirations 30, and temperature 97 F. She admits to the nurse that she has induced vomiting 3 times this morning, but she had to continue exercising to lose "just 5 more lb." Her symptoms are consistent with:

A.            Pregnancy

B.            Bulimia

C.            Gastritis

D.            Anorexia nervosa

NO.450 A 14-year-old boy fell off his bike while "popping a wheelie" on the dirt trails. He has sustained a head injury with laceration of his scalp over his temporal lobe. If he were to complain of headache during the first 24 hours of his hospitalization, the nurse would:

A.            Ask the physician to order a sedative

B.            Have the client describe his headache every 15 minutes

 C.           Increase his fluid intake to 3000 mL/24 hr

D.            Offer diversionary activities