Nokea
A client admitted to a surgical unit is being evaluated for an intestinal obstruction. The healthcare provider prescribes a nasogastric tube (NGT) to be inserted and placed to intermittent low wall suction. Which intervention should the nurse implement to facilitate proper tube placement?
- A. Soak nasogastric tube in warm water
- B. Insert tube with client's head tilted back
- C. Apply suction while inserting tube
- D. Elevate head of bed 60 to 90 degrees
Correct Answer: D
Rationale: Elevating the head of the bed helps facilitate proper placement of the NGT and reduces the risk of aspiration.
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Croup:
- A. Is a disease
- B. Is commonly caused by parainfluenza viruses
- C. Most cases are managed with nebulised adrenaline
- D. Inhaled steroids are reported to be of benefit
Correct Answer: B
Rationale: Croup is most commonly caused by parainfluenza viruses, which lead to inflammation of the larynx and trachea.
The following statements regarding retinoblastoma are correct:
- A. It is usually fatal even if diagnosis is made early
- B. The tumour is heritable
- C. They may occur bilaterally
- D. The finding of leucorrhoea suggests the diagnosis
Correct Answer: B
Rationale: Retinoblastoma is heritable and can occur bilaterally. Early diagnosis improves prognosis, and leucorrhoea is not associated with retinoblastoma.
The following factors trigger renin secretion:
- A. Hyponatremia
- B. ACTH
- C. Hypovolemia
- D. ADH
Correct Answer: C
Rationale: Hypovolemia: Renin is secreted by the kidneys in response to low blood volume (hypovolemia), initiating the renin-angiotensin-aldosterone system to conserve sodium and increase blood pressure.
The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?
- A. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest.
- B. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body.
- C. If the baby turns blue, I will immediately put the baby upright in an infant seat.
- D. If the baby turns blue, I will put the baby in supine position with his head elevated.
Correct Answer: A
Rationale: In the event of a paroxysmal hypercyanotic or tet spell, the infant should be placed in a knee-chest position.
An older female client with long term type 2 diabetes mellitus (DM) is seen in the clinic for a routine health assessment. To determine if the client is experiencing any long-term complication of DM, which assessments should the nurse obtain?
- A. Serum creatinine and blood urea nitrogen (BUN)
- B. Sensation in feet and legs
- C. Skin condition of lower extremities
- D. Visual acuity
Correct Answer: B
Rationale: These assessments are crucial for detecting complications such as neuropathy, nephropathy, and retinopathy.