Nokea
A client with diabetes asks the nurse for advice regarding methods of birth control. Which method of birth control is most suitable for the client with diabetes?
- A. Intrauterine device
- B. Oral contraceptives
- C. Diaphragm
- D. Contraceptive sponge
Correct Answer: C
Rationale: The diaphragm is suitable for diabetic clients as it avoids hormonal effects that could impact glucose control.
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A nurse is working in a residential facility when a fire breaks out in one hallway. The nurse and an elderly client are trapped in the client's room and cannot get out. The nurse should
- A. crawl in the closet with the client and shut the door.
- B. open a window in the client's room.
- C. instruct the client to crawl under the bed.
- D. leave the door to the room open.
Correct Answer: B
Rationale: Opening a window provides ventilation and a potential escape route while avoiding smoke inhalation. Keeping the door closed prevents smoke entry, and crawling under the bed or in a closet is unsafe.
A 23-year-old woman at 32-weeks gestation is seen in the outpatient clinic. Which of the following findings, if assessed by the nurse, would indicate a possible complication?
- A. The client’s urine test is positive for glucose and acetone.
- B. The client has 1+ pedal edema in both feet at the end of the day.
- C. The client complains of an increase in vaginal discharge.
- D. The client says she feels pressure against her diaphragm when the baby moves.
Correct Answer: A
Rationale: abnormal finding, could indicate gestational diabetes (GDM), hazard of placental insufficiency
The teenager with a fiberglass cast asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best?
- A. It will be alright for your friends to autograph the cast.
- B. Because the cast is made of plaster, autographing can weaken the cast.
- C. If they don't use chalk to autograph, it is okay.
- D. Autographing or writing on the cast in any form will harm the cast.
Correct Answer: A
Rationale: Autographing a fiberglass cast does not compromise its integrity, making it safe.
A client with a gastrointestinal bleed has an NG tube to low continuous wall suction. Which technique is the correct procedure for the nurse to utilize when assessing bowel sounds?
- A. Insert 10 mL of air in the NG tube and listen over the abdomen with a stethoscope
- B. Clamp the tube while listening to the abdomen with a stethoscope
- C. Irrigate the tube with 30 mL of NS while auscultating the abdomen
- D. Turn the suction on high and auscultate over the naval area
Correct Answer: B
Rationale: Clamping the NG tube prevents suction noise from interfering with auscultation, allowing accurate assessment of bowel sounds.
The nurse is caring for clients on the neurology unit. What would be the MOST appropriate action for the nurse to take after noting that a client suddenly developed a fixed and dilated pupil?
- A. Reassess in five minutes.
- B. Check the client’s visual acuity.
- C. Lower the head of the client’s bed.
- D. Contact the physician.
Correct Answer: D
Rationale: implementation, fixed and dilated pupil represents a neurological emergency