Clinical manifestations seen in left-sided rather than in right-sided heart failure are:

• A.Elevated central venous pressure and peripheral edema
• B.Dyspnea and jaundice
• C.Hypotension and hepatomegaly
• D.Decreased peripheral perfusion and rales

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A male client is experiencing auditory hallucinations. His nurse enters the room and he tells her that his mother is talking to him, and he will take his medicine after she leaves. The nurse looks around the room and sees that she and the client are the only ones in the room. The nurse's most therapeutic response will be:

• A."I don't see your mother in the room. Let's talk about how you're feeling."
• B."OK, I'll come back later when you're feeling more like taking your medicine."
• C."She may be here, but I can't see her."
• D."Why don't you finish talking to her, and I'll wait."

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A premature infant needs supplemental O2 therapy. A nursing intervention that reduces the risk of retrolental fibroplasia is to:

• A.Maintain O2at <40%
• B.Maintain O2at>40%
• C.Give moist O2at>40%
• D.Maintain on 100% O2

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A client has begun to exhibit signs of alcohol withdrawal. Her blood pressure has risen from 120/60 to
190/100, pulse is increased from 88 to 110 bpm, and she is irritable and agitated and has gross motor tremors of the hands. The nurse notifies the doctor. The nurse can anticipate that the doctor will order which of the following?

• A.An opiate such as propoxyphene napsylate (Darvocet)
• B.A benzodiazepine such as chlordiazepoxide (Librium)
• C.A tricyclic antidepressant such as amitriptyline (Elavil)
• D.A phenothiazine such as chlorpromazine (Thorazine)

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A 17-year-old client has a T-4 spinal cord injury. At present, he is learning to catheterize himself. When he says, "This is too much trouble. I would rather just have a Foley.'' An appropriate response for the RN teaching him would be:

• A."I know. It is a lot to learn. In the long run, though, you will be able to reduce infections if you do an intermittent catheterization program.''
• B."It is not too much trouble. This is the best way to manage urination.''
• C."OK. I'll ask your physician if we can replace the Foley.''
• D."You need to learn this because your doctor ordered it.''

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