Nokea
A infant weighs 7 pounds at birth. The expected weight by 1 year should be:
- A. 10 pounds
- B. 12 pounds
- C. 18 pounds
- D. 21 pounds
Correct Answer: D
Rationale: Infants typically triple their birth weight by 1 year, so a 7-pound infant should weigh approximately 21 pounds.
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A client's wife states that her elderly husband has begun to slightly slur his words and drop word endings, he has become increasingly withdrawn socially, and he is irritable, accusing her of talking behind his back and whispering at him. The nurse suspects that the client should be initially evaluated for which of the following?
- A. Depression.
- B. Alzheimer's disease.
- C. Hearing loss.
- D. Stroke.
Correct Answer: C
Rationale: Slurred speech, social withdrawal, and irritability with accusations of whispering suggest hearing loss (C), which can cause communication difficulties and paranoia. Depression (A), Alzheimer's (B), and stroke (D) are less likely to present with this specific combination.
A client undergoing 'cold-turkey' withdrawal from years of substance abuse is most at risk of serious life-threatening complications with which of the following substances?
- A. Heroin.
- B. Cocaine.
- C. Alcohol.
- D. Marijuana.
Correct Answer: C
Rationale: Alcohol withdrawal (C) can cause life-threatening complications like seizures and delirium tremens. Heroin (A), cocaine (B), and marijuana (D) withdrawal, while uncomfortable, are less likely to be fatal.
A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The nurse should tell the client to avoid taking:
- A. Aspirin
- B. Multivitamins
- C. Omega 3 fish oils
- D. Acetaminophen
Correct Answer: A
Rationale: Aspirin can increase methotrexate toxicity by reducing its renal excretion, leading to potentially severe side effects.
The nurse is caring for a client following a Whipple procedure. The nurse notes that the drainage from the nasogastric tube is bile tinged in appearance and has increased in the past hour. The nurse should:
- A. Document the finding and continue to monitor the client
- B. Irrigate the drainage tube with 10 mL of normal saline
- C. Decrease the amount of intermittent suction
- D. Notify the physician of the findings
Correct Answer: D
Rationale: Increased bile-tinged drainage may indicate a complication, such as a leak, requiring physician notification.
A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse?
- A. Meperidine 100 mg IM q 4 hours PRN pain
- B. Mylanta 30 ccs q 4 hours via NG
- C. Cimetadine 300 mg PO q.i.d.
- D. Morphine 8 mg IM q 4 hours PRN pain
Correct Answer: D
Rationale: Morphine can cause sphincter of Oddi spasm, worsening pancreatitis pain, so it should be questioned; meperidine is preferred.