单选题A 38-year-old client is hospitalized with obsessive-compulsive disorder. On admission, she becomes nervous and asks to go to the bathroom to brush her teeth. Her husband says that she brushes her teeth at least 25 times per day. The nurse notes that the client’s gums are inflamed and bleeding. What’s the best nursing intervention（）
单选题When completing an assessment of a healthy adolescent client, which of
the following would be most appropriate?
A. Obtain a detailed account of the adolescent's prenatal and early
developmental history.
B. Discuss sexual preferences and behaviors with the parents present for
legal reasons.
C. Discuss the client's smoking with parents present in the room.
D. Assess the adolescent in private; gather additional information from the
parents.
单选题A client with heart failure develops pink frothy sputum, coarse crackles, and restlessness. Which of the following actions should the nurse take first ？（）
单选题After staying several hours with her 10-year-old daughter who is admitted to the hospital with an asthmatic attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings would lead the nurse to make a nursing diagnosis of Anxiety related to respiratory distress? A. Complaints of an inability to get comfortable. B. Frequently requests for someone to stay in the room. C. Inability to remember his exact address. D. Verbalization of a feeling of tightness in his chest.
单选题Mr. Smith is admitted to the psychiatric hospital for evaluation after
numerous incidents of threatening, angry outbursts and two episodes of hitting a
coworker at the grocery store where he works. He is very anxious and tells the
nurse, "I didn't mean to hit him. He made me so mad that I just couldn't help
it. I hope I don't hit anyone here. " Which of the following is the nurse's best
response?
A. "It sounds like you were angry. When you feel angry here, talk to the
staff about it instead of hitting. "
B. "I'm sure you didn't mean to hit him and that it won't happen here.
"
C. "You'd better not hit anyone here, even if you do get mad. "
D. "Tell me more about what happened. "
单选题Which of the following would the nurse interpret as indicating that a child is receiving too much intravenous fluid too rapidly? A. Marked increase in abdominal girth. B. Evidence of protein in the urine. C. Dark amber colored urine. D. Moist crackles in the lung fields.
单选题The nurse is caring for a client who is on ritodrine therapy to halt premature labor. What condition indicates an adverse reaction to ritodrine therapy? A. Hypoglycemia. B. Crackles. C. Bradycardia. D. Hyperkalemia.
单选题While auscultating heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as A. a first heart sound (S1). B. a third heart sound (S3). C. a fourth heart sound (S4). D. a murmur.
单选题A 33-year-old male client is admitted with an exacerbation of ulcerative colitis. The nurse is performing an admission assessment and assessing the teaching needs regarding appropriate diet and lifestyle modifications for the client. To develop an effective teaching plan, the nurse must solicit which of the following input from the client? A. Details about his childhood phobias. B. His feelings, beliefs, and attitudes about his chronic illness. C. Information about his financial status. D. Information about his relationship with his wife.
单选题A 13-year-old visits the school nurse because he's experiencing back pain, fatigue, and dyspnea. The nurse suspects that the child may have scoliosis. The nurse should first A. send the child home to recover. B. inspect the child for uneven shoulder height or uneven hip height. C. arrange for the child to have spinal X-rays as soon as possible. D. ask the child's parent to take him to a physician immediately.
单选题A client is recovering from a gastric resection for peptic ulcer disease. Which of the following outcomes indicates that the goal of adequate nutritional intake is being achieved 3 weeks following surgery? A. Increases food intake and tolerance gradually. B. Experiences occasional episodes of nausea and vomiting. C. Experiences a rapid weight gain within 1 week. D. Drinks 2000 mL/day of water.
单选题The nurse is caring for a client infected with methicillin-resistant Staphylococcus aureus (MRSA). What's the major infection control measure to reduce MRSA and other nosocomial pathogens in a health care setting? A. Using antibacterial soap when bathing clients with MRSＡ. B. Conducting culture surveys periodically. C. Ensuring that personnel wash their hands before and after contact with every client. D. Using specific housekeeping practices for environmental cleaning.
单选题A client received burns to his entire back and left arm. Using the Rule of Nines, the nurse can calculate that he has sustained burns on what percentage of his body? A. 9%. B. 18%. C. 27%. D. 36%.
单选题The nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse can A. prepare the child by positive self-talk. B. establish a time limit to get ready for the procedure. C. hold and rock him and give him a security object. D. count and sing with the child.
单选题Many popular entertainments involve us in vivid portrayals of violence and/or sexuality. Freud might argue that the success of such movies is due to the mechanism of A．Transference B．Libido C．Ego development D．Sublimation
单选题Nursing care for a client after electroeonvulsive therapy (ECT) should
include which of the following?
A. Nothing by mouth for 24 hours after the treatment because of the
anesthetic agent.
B. Bed rest for the first 8 hours after a treatment.
C. Assessment of short-term memory loss.
D. No special care.
单选题A client's blood glucose level is 45 mg/dL. The nurse should be alert for which signs and symptoms? A. Coma, anxiety, confusion, headache, and cool, moist skin. B. Kussmaul's respirations, dry skin, hypotension, and bradycardia. C. Polyuria, polydipsia, hypotension, and hypernatremia. D. Polyuria, polydipsia, polyphagia, and weight loss.
单选题Which of the following would the nurse teach the mother of a child with leukemia who has an absolute neutrophil count of 900/mm3? A. The child should wear gloves when in contact with others. B. The child should stay away from crowds of people. C. The child should eat raw fruits and vegetables. D. Anyone in direct contact with the child must wear a gown and mask.
单选题Which one is not common factor attributing to the child abuse? A．Family stress factors B．Parent's psychological factors C．Social factors D．Children's knowledge
单选题A client is admitted to the emergency department with a suspected
overdose of an unknown drug. The client's arterial blood gas values indicate
respiratory acidosis. What should the nurse do first?
A. Prepare to assist with ventilation.
B. Monitor the client's heart rhythm.
C. Prepare to begin gastric lavage.
D. Obtain urine for drug screening.