Nokea
What is the major developmental task that the mother must accomplish during the first trimester of pregnancy?
- A. Acceptance of the pregnancy
- B. Acceptance of the termination of the pregnancy
- C. Acceptance of the fetus as a separate and unique being
- D. Satisfactory resolution of fears related to giving birth
Correct Answer: A
Rationale: Acceptance of the pregnancy. During the first trimester the maternal focus is directed toward acceptance of the pregnancy and adjustment to the minor discomforts.
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Health care provider prescription
Guaifenesin 600 mg/dextromethorphan hydrobromide 30 mg ER one tablet PO q12h PRN for thick secretions
The nurse prepares to administer an oral expectorant to a client with pneumonia. The client tells the nurse, 'That pill is too big. I won't be able to swallow it.' What is the best action by the nurse?
- A. Contact the pharmacy and request the liquid form of the medication.
- B. Crush the medication and place it in a small amount of applesauce.
- C. Instruct the client to tuck chin to chest while swallowing the tablet.
- D. Obtain a new prescription for the liquid form of the medication.
Correct Answer: A
Rationale: Contacting the pharmacy for a liquid form addresses the client's difficulty swallowing the pill, ensuring medication adherence without altering the drug inappropriately.
In reviewing the assessment data of a client suspected of having diabetes insipidus, the nurse expects which of the following after a water deprivation test?
- A. Increased edema and weight gain
- B. Unchanged urine specific gravity
- C. Rapid protein secretion
- D. Decreased blood potassium
Correct Answer: B
Rationale: Unchanged urine specific gravity. When fluids are restricted, the client continues to excrete large amounts of dilute urine. This finding supports the diagnosis. Normally, urine is more concentrated with reduced fluid intake.
A nurse is discussing the concept of parallel play with parents of toddlers. Which statement should the nurse include to describe this type of play?
- A. Children play near other children but without significant interaction.
- B. Children playing together are strongly influenced by each other's choice of toy.
- C. The child primarily plays alone or with familiar people, such as parents.
- D. When playing in a group, one child will take on a follower role.
Correct Answer: A
Rationale: Parallel play is characteristic of toddlers, where children play alongside each other without significant interaction, focusing on their own activities.
Following a typanoplasty, the nurse should maintain the client in which position?
- A. Semi-Fowler's with the operative ear facing down
- B. Low Trendelenburg with the head in neutral position
- C. Flat with the head turned to the side with the operative ear facing up
- D. Supine with a small neck roll to allow for drainage
Correct Answer: C
Rationale: After tympanoplasty, the client should be positioned flat with the head turned to the side and the operative ear facing up to promote healing and prevent pressure on the surgical site. Answer A is incorrect because the operative ear should face up, not down. Answer B is incorrect because low Trendelenburg is not indicated. Answer D is incorrect because a neck roll may not ensure proper positioning of the operative ear.
Laboratory results
Glucose (random)
71-200 mg/dL
(3.9–11.1 mmol/L) 58 mg/dL
(3.2 mmol/L)
The nurse is caring for a client with type 2 diabetes mellitus who reports feeling lightheaded and shaky. Which of the following actions should the nurse take next?
- A. Administer glucagon by subcutaneous injection as prescribed
- B. Administer rapid-acting insulin per sliding scale as prescribed
- C. Give the client 4 oz (120 mL) of fruit juice or a regular soft drink
- D. Give the client a snack of cheese or peanut butter with crackers
Correct Answer: C
Rationale: Lightheadedness and shakiness suggest hypoglycemia. Providing 15 grams of fast-acting carbohydrates, such as 4 oz of fruit juice, is the first-line treatment to raise blood glucose levels quickly.