Nokea
A 3-week-old neonate is brought to the emergency department because of a three-day history of intermittent vomiting. His mother reports that he has not urinated for eight hours. On physical examination, his eyes are sunken. Which of the following will MOST likely require correction before surgery is performed?
- A. Hypochloremia
- B. Hyperkalemia
- C. Hypernatremia
- D. N/A
Correct Answer: A
Rationale: Hypochloremia is often associated with dehydration and metabolic alkalosis, which may need correction before surgery.
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Janae has a seizure disorder; which of the following would be the lowest priority when caring for her? Observing and taking down data on all seizures
- A. Assuring safety and protection from injuring
- B. Assessing for signs and symptoms of increased intracranial pressure (ICP)
- C. Educating the family about anticonvulsant therapy
Correct Answer: C
Rationale: When caring for someone with a seizure disorder like Janae, the highest priority is ensuring their immediate safety and protection from injury during a seizure. This includes preventing falls, removing nearby hazards, and providing support during and after the seizure. Assessing for signs and symptoms of increased intracranial pressure is also important as it may indicate a serious complication requiring prompt medical attention. On the other hand, educating the family about anticonvulsant therapy, while important for long-term management, is considered a lower priority compared to the immediate safety and medical assessment needs of Janae during a seizure episode.
What are the periods in life when the need for iron increases?
- A. Pregnancy
- B. Infancy
- C. Old age
- D. Male reproductive years
Correct Answer: A
Rationale: The need for iron increases during pregnancy primarily due to the increased blood volume to support the growing fetus and placenta. Iron is essential for the production of hemoglobin, which helps transport oxygen to both the mother and the developing baby. Pregnant women often require more iron to prevent iron deficiency anemia, which can have negative effects on both the mother and the baby. It is important for pregnant women to consume enough iron-rich foods or take iron supplements as recommended by their healthcare provider to support a healthy pregnancy.
The LEAST important advice for a 2-month-old baby with excessive crying is
- A. master the situation in relaxed manner
- B. adhere to precry cues
- C. change milk formula
- D. avoid sensory overstimulation
Correct Answer: C
Rationale: Changing formula is less critical if the baby is gaining weight adequately.
A client has been diagnosed with renal failure and is admitted for dialysis. Which of the ff is the nurse's responsibility as the client undergone dialysis?
- A. Keeping dialysis supplies in a clean area
- B. Inspecting the catheter insertion site for signs of infection
- C. Weighing the client before and after the procedure
- D. washing hands before and after handling the catheter
Correct Answer: C
Rationale: The nurse's responsibility during dialysis includes weighing the client before and after the procedure. This is important to monitor the amount of fluid removed during dialysis and to ensure that the client's fluid balance is managed properly. It helps in determining the effectiveness of dialysis treatment in removing excess fluid from the body. Keeping the client's fluid balance in check is crucial in managing renal failure and preventing complications such as fluid overload. Therefore, monitoring the client's weight before and after dialysis is a key responsibility of the nurse in this situation.
Why may an ice collar be ordered for a client who is undergoing drainage of a peritonsillar abscess?
- A. To reduce swelling and pain
- B. To prevent respiratory obstruction
- C. To help the client drink fluids
- D. To prevent excessive bleeding
Correct Answer: B
Rationale: An ice collar may be ordered for a client undergoing drainage of a peritonsillar abscess to prevent respiratory obstruction. Peritonsillar abscess is a collection of pus behind the tonsils, and the inflammation and swelling from the abscess can lead to difficulty in breathing or swallowing. Applying an ice collar can help reduce the swelling and prevent the abscess from compressing the airway, thus reducing the risk of respiratory obstruction. It can provide comfort to the client and support the drainage process by minimizing the swelling and promoting better drainage of the abscess.