Which nurse should be assigned to care for the postpartal client with preeclampsia?
- A. The nurse with 2 weeks of experience on the postpartum unit
- B. The nurse with 3 years of experience in labor and delivery
- C. The nurse with 10 years of experience in surgery
- D. The nurse with 1 year of experience in the neonatal intensive care unit
Correct Answer: B
Rationale: The nurse with 3 years of experience in labor and delivery (answer B) should be assigned to care for the postpartal client with preeclampsia. This nurse has the most relevant experience and knowledge of possible complications associated with preeclampsia due to their background in labor and delivery. Assigning a nurse with only 2 weeks of experience on the postpartum unit (answer A) would not be suitable for handling the complexities of caring for a client with preeclampsia. Nurses with experience in surgery (answer C) or the neonatal intensive care unit (answer D) lack the specific expertise needed for managing a postpartal client with preeclampsia, making them unsuitable choices for this assignment.
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During discharge teaching for a client with diverticulitis on a low-roughage diet, which food should be eliminated from the diet?
- A. Roasted chicken
- B. Noodles
- C. Cooked broccoli
- D. Custard
Correct Answer: C
Rationale: The client with diverticulitis needs to avoid gas-forming foods that can increase abdominal discomfort. Cooked broccoli is a high-fiber food that can worsen symptoms. Roasted chicken, noodles, and custard are suitable choices for a low-roughage diet as they are less likely to cause gas formation or abdominal discomfort.
What should the charge nurse do after overhearing the patient care assistant speaking harshly to the client with dementia?
- A. Change the patient care assistant's assignment
- B. Explore the interaction with the patient care assistant
- C. Discuss the matter with the client's family
- D. Initiate a group session with the patient care assistant
Correct Answer: B
Rationale: The best action for the charge nurse to take is to explore the interaction with the patient care assistant. This step allows for clarification of the situation and direct addressing of the issue. Changing the patient care assistant's assignment (choice A) might be necessary, but understanding the situation should come first. Discussing the matter with the client's family (choice C) as an initial step could escalate the situation. Initiating a group session with the patient care assistant (choice D) could be considered later as a preventive measure to avoid similar incidents in the future.
An infant weighs 7 pounds at birth. What is the expected weight by 1 year of age?
- A. 10 pounds
- B. 12 pounds
- C. 18 pounds
- D. 21 pounds
Correct Answer: D
Rationale: A birth weight of 7 pounds typically triples by the age of 1 year, resulting in an expected weight of 21 pounds. This significant weight gain is a normal growth pattern for infants as they usually experience rapid growth in the first year of life. Choices A, B, and C are incorrect because they do not account for the usual growth rate of an infant in the first year. Infants commonly triple their birth weight by the age of 1, making 21 pounds the expected weight.
What is a common characteristic of a batterer?
- A. Grew up in a loving, secure home
- B. Was an only child
- C. Was physically or psychologically abused
- D. Admits they have a problem with anger
Correct Answer: C
Rationale: The correct answer is that a batterer is typically someone who was physically or psychologically abused. Research shows that many individuals who engage in abusive behavior report a history of being abused themselves. Choices A, B, and D are incorrect. While it is possible for a batterer to have grown up in a loving, secure home, been an only child, or acknowledge their anger issues, the most common factor associated with becoming a batterer is a history of being abused.
A client has been taking alprazolam (Xanax) for four years to manage anxiety. The client reports taking 0.5 mg four times a day. Which statement indicates that the client understands the nurse's teaching about discontinuing the medication?
- A. "I can drink alcohol now that I am decreasing my Xanax."?
- B. "I should not take another Xanax pill. Here is what is left of my last prescription."?
- C. "I should take three pills per day next week, then two pills for one week, then one pill for one week."?
- D. "I can expect to be sleepy for several days after stopping the medicine."?
Correct Answer: C
Rationale: Explanation: When discontinuing alprazolam (Xanax) after long-term use, it is crucial to taper the dosage gradually to prevent withdrawal symptoms. The correct statement indicates an understanding of this by planning a structured decrease in dosage over time. Choice A is incorrect as drinking alcohol while decreasing Xanax can be dangerous and is not recommended. Choice B is incorrect as abruptly stopping Xanax is not safe and can lead to withdrawal symptoms. Choice D is incorrect as expecting to be sleepy for several days after stopping the medication does not address the need for a gradual tapering process to avoid withdrawal symptoms.
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