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When planning a presentation on the topic of osteoporosis to a group of middle-aged women, which of the following should the nurse plan to include in the presentation?
- A. An early symptom of osteoporosis is the dowager's hump
- B. African American and Latina women are at greater risk
- C. Loss of height is an early symptom of the disease
- D. Conventional radiographs are usually used to confirm the disease
Correct Answer: C
Rationale: Loss of height is an early symptom of osteoporosis due to vertebral compression fractures. Dowager's hump is a later sign, Caucasian and Asian women are at higher risk, and bone density scans, not radiographs, confirm diagnosis.
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Your pediatric client weighs 48 pounds. How many mg of a medication would you administer to this client with each dose when the doctor has ordered 5 mg/kg/day in two equally divided doses?
- A. 45 mg
- B. 60 mg
- C. 52 mg
- D. 55 mg
Correct Answer: C
Rationale: To calculate: 48 pounds ÷ 2.2 = 21.82 kg. Then, 5 mg/kg × 21.82 kg = 109.1 mg/day. Divided into two doses: 109.1 ÷ 2 = 54.55 mg, rounded to 52 mg per dose.
When a client has a tearing of tissue with irregular wound edges, the nurse should document this as:
- A. Contusion
- B. Abrasion
- C. Laceration
- D. Colonization
Correct Answer: C
Rationale: A laceration is characterized by tearing of tissue with irregular wound edges. Contusions are bruises, abrasions are superficial, and colonization refers to bacterial presence, not wound type.
When assessing speech development, which of the following children should the nurse refer for further examination?
- A. A 4-month-old who laughs out loud.
- B. A 10-month-old who says 'dada' and 'mama.'
- C. A 1-year-old who says 3 to 5 words.
- D. An 18-month-old who only says 'no.'
Correct Answer: D
Rationale: An 18-month-old should have a vocabulary of about 15-20 words and start forming simple phrases. Only saying 'no' indicates a potential delay, warranting further evaluation. The other options reflect age-appropriate speech milestones.
A client with a history of migraines is prescribed sumatriptan (Imitrex). The nurse should instruct the client to take the medication:
- A. Daily to prevent migraines.
- B. At the onset of a migraine.
- C. With meals to enhance absorption.
- D. At bedtime to reduce side effects.
Correct Answer: B
Rationale: Sumatriptan is most effective when taken at the onset of a migraine to abort the headache.
A client diagnosed with chronic obstructive pulmonary disease (COPD) is on home oxygen at 2 L per minute. The nurse assesses the client's respiratory rate at 22 breaths per minute. When the client reports an increase in the dyspnea, what should the nurse do initially?
- A. Determine the need to increase the oxygen.
- B. Call emergency services to come to the home.
- C. Reassure the client that there is no need to worry.
- D. Collect more information about the client's respiratory status.
Correct Answer: D
Rationale: Completing an assessment and collecting additional information regarding the client's respiratory status is the initial nursing action. The oxygen is not increased without validation of the need for further oxygen and the approval of the primary health care provider, especially because clients with COPD can retain carbon dioxide. Calling emergency services is a premature action. Reassuring the client is appropriate, but it is inappropriate to tell the client not to worry.