mental health eaq #2

after a gastroscopy how does the nurse assess the client for the return of the gag reflex? 1.Touching the pharynx with a tongue depressor 2.Giving a small amount of water using an oral syringe 3.observing the client's swallowing ability 4.Instructing the client to breathe deeply and cough gently

1.Touching the pharynx with a tongue depressor

during a home visit the nurse observes the children and concludes that the family is democratic. which behavior of the family would lead to this conclusion? 1. The child's aunt cooks. 2. The child is respected as an individual. 3. The child's father makes all the decisions. 4. The child is bound to strict rules and expectations.

2. The child is respected as an individual.

The nurse sees a 4-year-old girl with a webbed neck and short stature. What could be the probable finding in genetic testing? 1.The child has mutated chromosome 47 with XXX inheritance. 2.The child has mutated chromosome 47 with XYY inheritance. 3.The child has mutated chromosome 45 with XO inheritance. 4.The child has mutated chromosome 48 with XXXY inheritance

3. The child has mutated chromosome 45 with XO inheritance.

which client response should the nurse monitor when assessing for complications of hyperparathyroidism? 1. Tetany 2. Seizures 3. Bone pain 4. Graves disease

3. bone pain

a client comes to the clinic complaining of a productive cough with copious yellow sputum, fever, and chills for the past two days. what is the primary nursing action when caring for this client? 1.Encourage fluids 2.Administer oxygen 3.Take the temperature 4.Collect a sputum specimen

3.Take the temperature

after a head injury a client develops a deficiency of ADH what should the nurse consider about the response to secretion of ADH before assessing this client? 1 .Serum osmolarity increases 2.Urine concentration decreases 3.Glomerular filtration decreases 4.Tubular reabsorption of water increases

4.Tubular reabsorption of water increases

which stage of family development involves decision making conflict resolution and communication? a. expectant stage b. parenthood stage c. senescence stage d. establishment stage

d. establishment stage

a nurse is caring for a client who had surgery for cancer of the pancreas. which nutrients are most influenced by the effects of this surgery? a. proteins and low fat dairy b. vitamins and minerals c. fluids and electrolytes d. fats and carbohydrates

d. fats and carbohydrates

which statement is true regarding the prospective payment system developed secondary to the balanced budget act of 1997? a. the PPS imposed an interim payment system to control home health expenditures b. the PPS implemented a new payment system to home health agencies to increase payments to clients c. the PPS imposed new limits on home health through a provision of the Balanced Budget Act (BBA) d. the PPS provided incentives to home health providers to deliver home health services more efficiently

d. the PPS provided incentives to home health providers to deliver home health services more efficiently

after undergoing a cardiac catheterization the client complains of tingling sensations in the affected leg. what should the nurse do to determine the cause of the tingling? a. assess for bleeding at the puncture site b. evaluate the affected leg for signs of inflammation c. compare femoral, popliteal, and pedal pulses in both legs d. obtain the temp, pulse, respirations, and blood pressure

c. compare femoral, popliteal, and pedal pulses in both legs

which client should a nurse consider the greatest risk for developing hypernatremia? a. 52 yr old who is recieving 0.45% NaCL IV b. 63 yr old who had watery diarrhea since traveling abroad c. 48 yr old who is admitted with a diagnosis of addison disease

b. 63 yr old who had watery diarrhea since traveling abroad

a client is brought to the emergency department after an automobile collison. the client BP is 100/60 mm Hg and the physical assessment suggests a ruptured spleen. for which early clinical indicator of decreased arterial pressure should the nurse assess the client? a. warm flushed skin b.increases pulse pressure c. lethargy with confusion d. reduced peripheral pulses

d. reduced peripheral pulses

several hours after administering insulin the nurse is assessing a client for an adverse response to the insulin. which client responses are indicative of hypoglycemic reaction? select all that apply 1. Confusion 2. Tremors 3. Anorexia 4. Glycosuria 5. Diaphoresis

1. Confusion 2. Tremors 5. Diaphoresis

a school nurse is teaching the parents of school aged children about the importance of immunizations for the childhood communicable diseases. what preventable disease may have the complication of encephalitis (inflammed brain)? 1. Varicella 2. Scarlet fever 3. Poliomyelitis 4. Whooping cough

1. Varicella

a client has surgery for creation of burr holes after sustaining head trauma. what is an early clinical manifestation of meningeal irritation for which the nurse assesses the client? A. Sunset eyes B. Kernig sign C. Plantar reflex D. Homans sign

B. Kernig sign

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client? A. Hypovolemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

D. Hypernatremia

which medication requires the nurse to monitor the client for signs of hyperkalemia? A. Furosemide B. Metolazone C. Spironolactone D. Hydrochlorothiazide

C. Spironolactone

during auscultation of the heart where does the nurse expect the first heart sound (s1) to be the loudest?

apex

the nurse is preparing to educate a group of clients about health promotion to prevent head and neck cancer. which clients are of highest priority for education? select all that apply a. client who chew tobacco b. client who has multiple sex partners c. client who uses condoms when having sex d. client with a history of alcohol abuse for 5 years e. client who brushes with a soft bristle toothbrush

a. client who chew tobacco b. client who has multiple sex partners d. client with a history of alcohol abuse for 5 years

a nurse is obtaining the health history from a 21 yr old client who is seeking contraceptive info. what factor in the clients history is a contraindication to the use of oral contraceptives? a. history of hypertension b. pack a day cigarette habit c. older than 30 yrs of age d. several multiple pregnancies

a. history of hypertension

a client admitted to the emergency department has ketones in the blood and urine. which situation associated with this physiological finding should be the nurses focus when collecting additional data about this client? a. starvation b. alcoholism c. bone healing d. + nitrogen balance

a. starvation

which growth patterns does the nurse anticipate observing when providing care to a newborn? select all that apply a. a 10% weight gain within the first few days of life b. an average birth length of 48 to 53 cm (19-21 in) c. average birth weight of 2700 to 4000 g (6-9 lbs) d. positive babinski reflex noted during admission assessment e. average head circumference of 33 - 35 cm (13 to 14 in)

b. an average birth length of 48 to 53 cm (19-21 in) c. average birth weight of 2700 to 4000 g (6-9 lbs) e. average head circumference of 33 - 35 cm (13 to 14 in)

which statements regarding muslim religious beliefs are correct? select all that apply a. autopsy is mandatory when a muslim dies b. cremation is forbidden when muslim dies c. a muslim infant must be baptized within 40 days after birth d. donation of organs is allowed after death e. muslim women should only removed religious jewelry when absolutely necessary

b. cremation is forbidden when muslim dies e. muslim women should only removed religious jewelry when absolutely necessary

a nurse is caring for a client with a diagnosis of cushing syndrome. what is the most common cause of cushing syndrome that the nurse should consider before assessing this client for physiological responses? a. pituitary hypoplasia b. hyperplasia of the adrenal cortex c. deprivation of adrenocortical hormones d. insufficient adrenocorticotropic hormone production

b. hyperplasia of the adrenal cortex

a client rescued from a burning building has partial and full thickness burns over 40% of the body. which initial physiologic change will the nurse expect? a. increase in blood volume b. increase in serum potassium c. decrese in capillary permeability

b. increase in serum potassium

a nurse cares for client with terminal pancreatic cancer the client tells the nurse i have some spiritual questions and would like to talk to someone. which member of the core interdisciplinary hospice team should be contacted a. social worker b. hospice volunteer c. spiritual coordinator d. bereavement coordinator

c. spiritual coordinator

which menstrual phase involves the release of estrogen from the maturing Graafian follicle?

days 6 through 13