Nokea
A 40 year old woman with aplastic anemia is prescribed estrogen with progesterone. The nurse can expect that these medications are given for which of the following reasons?
- A. To stimulate bone growth
- B. To enhance sodium and potassium
- C. To regulate fluid balance absorption
- D. To promote utilization and storage of fluids
Correct Answer: A
Rationale: The correct answer is A: To stimulate bone growth. Estrogen and progesterone are hormones that play a crucial role in maintaining bone density and promoting bone growth. In postmenopausal women or individuals with conditions like aplastic anemia, bone health can be compromised. Estrogen helps in preventing bone loss and maintaining bone strength, while progesterone also contributes to bone formation. Therefore, in this scenario, these medications are likely prescribed to help improve bone health in the woman with aplastic anemia.
Incorrect choices:
B: Estrogen and progesterone do not directly enhance sodium and potassium levels.
C: Estrogen and progesterone do not regulate fluid balance absorption directly.
D: Estrogen and progesterone do not specifically promote utilization and storage of fluids.
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A client on hemodialysis is complaining of muscle weakness and numbness in his legs. His lab results are: Na 136 mEq/L, K 5.9 mEq/L, Cl 100 mEq/L, ca 8.5 mg/dl. Which electrolyte imbalance is the client suffering from?
- A. Hyperkalemia
- B. Hypocalcemia
- C. Hypernatremia
- D. Hypochloremia
Correct Answer: A
Rationale: The correct answer is A: Hyperkalemia. In hemodialysis, potassium levels can be elevated due to impaired renal excretion. High potassium can lead to muscle weakness and numbness. The client's K level of 5.9 mEq/L is above the normal range (3.5-5.0 mEq/L), confirming hyperkalemia. Na, Cl, and Ca levels are within normal limits, ruling out hypernatremia, hypochloremia, and hypocalcemia as the client's primary electrolyte imbalance. Monitoring and managing hyperkalemia are crucial to prevent life-threatening complications like cardiac arrhythmias.
Which of the following is one of the discharge criteria from ambulatory surgery for patients following surgery?
- A. Able to drive self home
- B. IV narcotics given less than 30 minutes
- C. Has home telephone before discharge
- D. Understands discharge instructions
Correct Answer: D
Rationale: The correct answer is D: Understands discharge instructions. This is crucial for patient safety and recovery post-surgery. Understanding discharge instructions ensures patients know how to care for themselves at home, manage medications, recognize warning signs, and follow-up instructions. Choice A is incorrect as patients should not drive after surgery due to potential impairment. Choice B is incorrect as IV narcotics administration timing is not a discharge criterion. Choice C is irrelevant to the patient's readiness for discharge. Understanding discharge instructions is the key factor in ensuring the patient's well-being and recovery after ambulatory surgery.
While obtaining a health history, the nurse learns that the client is allergic to bee stings. When obtaining the client’s medication history, the nurse should determine if the client keeps which medication on hand?
- A. Diphenhydramine hydrochloride (Benadryl)
- B. Guaifenesin (Robitussin)
- C. Pseudoephedrine hydrochloride (Sudafed)
- D. Loperamide (Imodium)
Correct Answer: A
Rationale: Rationale:
A: Diphenhydramine hydrochloride (Benadryl) is an antihistamine commonly used to treat allergic reactions, including those from bee stings. It can help alleviate symptoms like itching and swelling. Keeping Benadryl on hand is crucial for managing an allergic reaction promptly.
Other Choices:
B: Guaifenesin (Robitussin) is an expectorant used to treat coughs, not allergic reactions.
C: Pseudoephedrine hydrochloride (Sudafed) is a decongestant used for nasal congestion, not allergic reactions.
D: Loperamide (Imodium) is an antidiarrheal used to treat diarrhea, not allergic reactions.
What is the primary purpose of using measurable client outcomes during the nursing process?
- A. To diagnose client conditions accurately.
- B. To evaluate the effectiveness of nursing interventions.
- C. To prioritize nursing diagnoses effectively.
- D. To guide documentation in the client’s health record.
Correct Answer: B
Rationale: The primary purpose of using measurable client outcomes during the nursing process is to evaluate the effectiveness of nursing interventions. This is crucial in determining whether the care provided has led to the desired outcomes for the client's health. By measuring outcomes, nurses can assess if the interventions are successful, make any necessary adjustments to the care plan, and ensure optimal patient outcomes.
Choice A is incorrect because diagnosing client conditions accurately is not the primary purpose of using measurable client outcomes; it is more related to the initial assessment phase.
Choice C is incorrect because prioritizing nursing diagnoses effectively is an important aspect of the nursing process, but it is not the primary purpose of using measurable client outcomes.
Choice D is incorrect because while documentation in the client's health record is important, it is not the primary purpose of using measurable client outcomes.
The first thing to do for a nurse when an accident occurs is to find out if patient is conscious so that she could:
- A. Reassure the patient
- B. Call relatives
- C. Bring patient immediately to the hospital
- D. Call a doctor
Correct Answer: A
Rationale: The correct answer is A: Reassure the patient. The first priority in any accident scenario is to ensure the patient's safety and well-being. By checking if the patient is conscious, the nurse can assess their immediate condition and provide reassurance to alleviate any distress or anxiety. This step establishes communication and trust, allowing for further assessment and appropriate actions to be taken. Calling relatives (B) may be important but not the immediate first step. Bringing the patient immediately to the hospital (C) is premature without assessing the patient first. Calling a doctor (D) can be done after assessing the patient's condition.