20 - Nursing Competitive Exams QAs - NORCET, ESIC

Question 6191) 

What nursing action will limit hypoxia when suctioning a client's airway? 

A. Apply suction only after catheter is inserted. 

B. Limit suctioning with catheter to half a minute. 

C. Lubricate the catheter with saline before insertion. 

D. Use a sterile catheter for each suctioning episode. 

Answer: A 

Explanation: The negative pressure from suctioning removes oxygen as well as secretions, suction should be applied only after the catheter is inserted and is being withdrawn. 

Question 6192) 

The arterial blood gases of a client with chronic obstructive a pulmonary disease (COPD) deteriorate, and respiratory failure is impending. For which clinical indicator should the nurse assess first? 

A. Cyanosis 

B. Bradycardia 

C. Mental confusion 

D. Distended neck veins 

Answer: C 

Explanation: Decreased oxygen to the vital centers in the brain results in restlessness and confusion. 

Question 6193) A nurse identifies that the client understands information about vitamin K when the client states, Vitamin K is : 

A. found in a variety of foods, so there is no danger of deficiency. 

B. easily absorbed without assistance, so everything eaten is absorbed. 

C. rarely found in dietary foods, so a natural deficiency can easily occur. 

D. produced in sufficient amounts by intestinal bacteria, so metabolic needs are met. Answer: D 

Explanation: vitamin K is synthesized by intestinal bacteria but is also found in large quantities in green leafy vegetables. 

Question 6194) 

A nurse is teaching a client how to use the call bell system. Which level of Maslow's Hierarchy of Needs does this nursing action address? 

A. Safety 

B. Self-esteem 

C. Physiologic 

D. Interpersonal 

Answer: A 

Explanation: A call bell system enables the client to communicate with the staff and support safety and security,which is a second level need. 

Question 6195) 

Which nurse collaborates directly with the client to establish and implemented a basic plan of care after admission? 

A. Primary nurse 

B. Nurse clinician 

C. Nurse coordinator 

D. Clinical nurse specialist 

Answer: A 

Explanation: The primary nurse provides or oversees all aspects of care, including assessment, implementation and evaluation of that care. 

Question 6196) A pregnant client is now in the third trimester. The client tells the nurse, "I want to be knocked out for the birth." How should the nurse respond? 

A. You are worried about too much pain. 

B. You don't want to be awake during the birth. 

C. I can understand that because labor is uncomfortable. 

D. I will tell your health care provider about this request. 

Answer: A 

Explanation: Paraphrasing encourages the client to express the rationale for this request. 

Question 6197) 

What should a nurse consider when trying to promote affective learning in a client with a newly diagnosed disease? 

A. Client's past experiences 

B. Client's personal resources 

C. Stress of the total situation 

D. Type of onset of the disease 

Answer: A 

Explanation: Past experiences have the most meaningful influence on present learning. 

Question 6198) 

What clinical finding does a nurse anticipate when admitting a client with an extracellular fluid volume excess? 

A. Rapid, thready pulse 

B. Distended jugular veins 

C. Elevated hematocrit level 

D. Increased serum sodium level 

Answer: B 

Explanation: Because of fluid overload in the intravascular space, the neck veins become visibly distended. 

Question 6199) A client reports vomiting and diarrhea for 3 days. What clinical finding will most accurately indicate that the client has a fluid deficit? 

A. Presence of dry skin 

B. Loss of body weight 

C. Decrease in blood pressure 

D. Altered general appearance 

Answer: B 

Explanation: Dehydration is most readily and accurately measured by serial assessments of body weight: 1 L of fluid weighs 2.2 lb. 

Question 6200) 

A nurse assesses a client's serum electrolyte levels in the laboratory report. What electrolyte in intracellular fluid should the nurse consider most important? 

A. Sodium 

B. Calcium 

C. Chloride 

D. Potassium 

Answer: D 

Explanation: The concentration of potassium is greater inside the cell and is important in establishing a membrane potential, a critical factor in the cell's ability to function.