Nokea
Which of the following actions should the nurse take first?
- A. Teach the client how to insert the diaphragm
- B. Document the client's level of understanding about potential adverse effects.
- C. Supervise return demonstration of diaphragm use
- D. Determine the client's knowledge about diaphragm use
Correct Answer: D
Rationale: Assessing the client’s current knowledge is the first step in patient education.
You may also like to solve these questions
The nurse should first address the client's.... followed by the client's....
- A. lung, sounds
- B. pain level
- C. bowel sounds
- D. blood glucose level
- E. blood pressure
- F. temperature
Correct Answer: E,F
Rationale: The correct answer is E,F. Firstly, addressing the client's blood pressure (E) is crucial as it assesses cardiovascular health and can indicate potential immediate risks. Secondly, addressing the client's temperature (F) is important as it can indicate infection or other health issues. Choices A, B, C, and D are not the priority as they do not directly relate to immediate cardiovascular or infection risks like blood pressure and temperature do.
A nurse is assessing a client who is taking haloperidol and is experiencing pseudo parkinsonism. Which of the following findings should the nurse document as a manifestation of pseudo parkinsonism?
- A. Serpentine limb movement
- B. Shuffling gait
- C. Nonreactive pupils
- D. Smacking lips
Correct Answer: B
Rationale: The correct answer is B: Shuffling gait. Pseudo parkinsonism is a common side effect of antipsychotic medications like haloperidol. A shuffling gait is a characteristic manifestation, which includes slow, shuffling, and stiff movements resembling those seen in Parkinson's disease. This occurs due to the blockade of dopamine receptors in the brain.
Choice A, serpentine limb movement, is not a typical manifestation of pseudo parkinsonism. Choice C, nonreactive pupils, is more indicative of a possible neurological issue. Choice D, smacking lips, is a manifestation of tardive dyskinesia, not pseudo parkinsonism.
For each potential provider's prescription, click to specify if the potential prescription is anticipated or unanticipated for the client.
- A. Place client in supine position
- B. Limit fluid intake to 3,000 mL/day
- C. Administer oxytocin
- D. Maintain bed rest with bathroom privileges
- E. Administer betamethasone.
- F. Administer terbutaline.
Correct Answer: D,E,F
Rationale: [0, 0, 0, 1, 1, 1]
For the correct answer :
- D: Maintaining bed rest with bathroom privileges is anticipated as it helps in preventing physical strain while allowing essential movement.
- E: Administering betamethasone is anticipated for fetal lung maturation in preterm labor.
- F: Administering terbutaline is anticipated for delaying preterm labor by relaxing uterine muscles.
Other choices:
- A: Placing the client in a supine position is not anticipated as it can decrease blood flow to the fetus.
- B: Limiting fluid intake to 3,000 mL/day is not anticipated as hydration is vital during pregnancy.
- C: Administering oxytocin is not anticipated unless there is a specific indication for labor induction.
Which of the following actions should the nurse take first?
- A. Meet with providers to discuss measures so decrease the infections
- B. Identify possible precipitating factors related to the infections
- C. Schedule nursing staff training for infection control procedures
- D. Revise the current policy for catheter care
Correct Answer: B
Rationale: Identifying causes directs targeted interventions.
For each finding. click to specify if the finding is consistent with pancreatitis or peritonitis Each finding may support more than one disease process.
- A. Bloody stools
- B. Hyperbilirubinemia
- C. Abdominal pain
- D. Elevated WBC court
Correct Answer: A,B,C,D
Rationale: The correct answer is .
Rationale:
1. Bloody stools can be seen in both pancreatitis and peritonitis due to gastrointestinal bleeding.
2. Hyperbilirubinemia is a common finding in pancreatitis due to obstruction of the bile duct by edema or inflammation.
3. Abdominal pain is a hallmark symptom of both pancreatitis and peritonitis, indicating inflammation or irritation of the abdominal structures.
4. Elevated WBC count is a sign of infection or inflammation, which can be present in both pancreatitis and peritonitis.
Summary:
- Bloody stools: Supports both pancreatitis and peritonitis.
- Hyperbilirubinemia: Supports pancreatitis.
- Abdominal pain: Supports both pancreatitis and peritonitis.
- Elevated WBC count: Supports both pancreatitis and peritonitis.
Other choices are incorrect because they do not align with the typical clinical presentations of pancreatitis