Nokea
The nurse is teaching a woman the normal changes of pregnancy. Which statement by the woman indicates correct understanding?
- A. There is decreased oxygen consumption during pregnancy.'
- B. There is an increased rate of peristalsis in the GI tract.'
- C. I will have a 50% increase in blood volume.'
- D. My metabolic rate will decrease.'
Correct Answer: C
Rationale: Pregnancy increases blood volume by about 50% to support fetal circulation, a correct understanding. Oxygen consumption and metabolic rate increase, and peristalsis slows.
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A 15-month-old child has just been diagnosed with sickle cell anemia. The mother is pregnant and asks if the child she is carrying will also have sickle cell anemia. She says that neither she nor her husband has sickle cell anemia. The nurse's reply should be based on which understanding?
- A. There is a 50% chance that each child they have will have sickle cell anemia.
- B. The chance of having another child with sickle cell anemia is 1 in 4.
- C. Parents do not usually have two children in a row with sickle cell anemia.
- D. If the child is a boy, there is a 50% chance that he will have sickle cell anemia.
Correct Answer: B
Rationale: Sickle cell anemia is autosomal recessive; if both parents are carriers (trait), there's a 25% (1 in 4) chance per child of inheriting the disease, independent of gender or prior children.
A nurse is working in an outpatient orthopedic clinic. During the patient's history the patient reports, 'I tore 3 of my 4 Rotator cuff muscles in the past.' Which of the following muscles cannot be considered as possibly being torn?
- A. Teres minor
- B. Teres major
- C. Supraspinatus
- D. Infraspinatus
Correct Answer: B
Rationale: Teres Minor, Infraspinatus, Supraspinatus, and Subscapularis make up the Rotator Cuff.
The nurse is caring for a client with a history of schizophrenia who is receiving haloperidol (Haldol) 5 mg PO bid. Which of the following symptoms should the nurse report immediately?
- A. Dry mouth.
- B. Mild sedation.
- C. Muscle stiffness and tremors.
- D. Insomnia.
Correct Answer: C
Rationale: Muscle stiffness and tremors suggest extrapyramidal symptoms, a serious haloperidol side effect. Options A, B, and D are less urgent.
The nurse is caring for a client with a history of peptic ulcer disease.
- A. Which dietary instruction is most appropriate for a client with peptic ulcer disease?
- B. Avoid spicy foods and caffeine.
- C. Eat large meals three times daily.
- D. Consume high-fat foods to coat the stomach.
- E. Drink alcohol in moderation.
Correct Answer: A
Rationale: Avoiding spicy foods and caffeine reduces gastric irritation in peptic ulcer disease. Small, frequent meals are preferred, high-fat foods delay healing, and alcohol exacerbates ulcers.
The nurse is teaching a community group about how to prevent Lyme disease. What should be included in the teaching? Select all that apply.
- A. Wear dark-colored clothing when outdoors.
- B. Tuck long pants inside socks.
- C. Wear long sleeves and long pants when outside.
- D. Remove standing water.
- E. Use insect repellant containing DEET.
- F. Do not eat venison.
Correct Answer: B,C,E
Rationale: Tucking pants into socks, wearing long clothing, and using DEET repel ticks, preventing Lyme disease. Light clothing aids tick visibility, standing water is irrelevant, and venison is safe.