Nokea
A labor and delivery nurse is caring for a newborn baby whose mother was a regular cocaine user during the entire pregnancy (prenatal cocaine exposure). The nurse expects the newborn to
- A. present with irritability, trouble sleeping, and a shrill cry.
- B. present with lethargy, poor muscle tone, and inability to cry.
- C. require pharmaceutical support for cocaine withdrawal.
- D. benefit from a regular breastfeeding schedule.
Correct Answer: A
Rationale: Prenatal cocaine exposure causes neonatal irritability, sleep disturbances, and a shrill cry due to central nervous system stimulation.
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A client with cervical cancer has a radioactive implant. Which statement indicates that the client understands the nurse's teaching regarding radioactive implants?
- A. I won't be able to have visitors while getting radiation therapy.
- B. I will have a urinary catheter while the implant is in place.
- C. I can be up to the bedside commode while the implant is in place.
- D. I won't have any side effects from this type of therapy.
Correct Answer: C
Rationale: Clients with radioactive implants can use the bedside commode if the implant remains secure, indicating understanding of mobility restrictions to minimize radiation exposure.
The nurse is caring for a client with systemic lupus erythematosis (SLE). The major complication associated with systemic lupus erythematosis is:
- A. Nephritis
- B. Cardiomegaly
- C. Desquamation
- D. Meningitis
Correct Answer: A
Rationale: Nephritis is the major complication of SLE due to immune complex deposition in the kidneys, leading to lupus nephritis, which can cause renal failure if untreated.
What would the nurse expect the admitting assessment to reveal in a client with glomerulonephritis?
- A. Hypertension
- B. Lassitude
- C. Fatigue
- D. Vomiting and diarrhea
Correct Answer: A
Rationale: Glomerulonephritis often causes hypertension due to fluid retention and renal dysfunction.
The nurse is caring for a client receiving peritoneal dialysis. Which of the following assessment findings would require an intervention by the nurse?
- A. Abdominal discomfort during infusion of dialysate.
- B. Presence of constipation.
- C. Cloudy dialysate output.
- D. Ecchymosis around peritoneal catheter.
Correct Answer: C
Rationale: indicates peritonitis, also will see nausea and vomiting, anorexia, abdominal pain, tenderness, rigidity
The nurse is caring for a client who abuses narcotics. The client is exhibiting a respiratory rate of 10 and dilated pupils. Which drug would the nurse expect to administer?
- A. Meperidine (Demerol)
- B. Naloxone (Narcan)
- C. Chlordiazepoxide (Librium)
- D. Haloperidol (Haldol)
Correct Answer: B
Rationale: Respiratory depression (rate of 10) and dilated pupils suggest opioid overdose. Naloxone (Narcan) is the antidote to reverse opioid toxicity.