Nokea
A client in a cardiac rehabilitation program states that he would like to make sure he is eating the right foods to ensure adequate endurance on the treadmill. Which of the following nutrients is most helpful for promoting endurance during sustained activity?
- A. Protein.
- B. Carbohydrate.
- C. Fat.
- D. Water.
Correct Answer: B
Rationale: Carbohydrates are the primary energy source for sustained physical activity, providing glycogen stores for endurance.
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One of the primary purposes of a formal medication reconciliation is to:
- A. Prevent polypharmacy
- B. Conserve financial resources
- C. Prevent interactions
- D. Prevent allergies
Correct Answer: C
Rationale: Medication reconciliation compares current and previous medication lists to identify and prevent potential drug interactions, ensuring safe prescribing.
The nurse is obtaining a health history from a Mexican American adult. The nurse should interpret the findings by understanding that Mexican American culture most highly values:
- A. Children
- B. Materialism
- C. Firstborn sons
- D. The elderly
Correct Answer: A
Rationale: Mexican American culture often places high value on children, emphasizing family and intergenerational bonds. Materialism, firstborn sons, and the elderly are valued but not as universally central.
A client with a history of burns is admitted with a 40% total body surface area injury. The nurse should prioritize which of the following interventions?
- A. Initiate fluid resuscitation.
- B. Administer prophylactic antibiotics.
- C. Apply ice to the burns.
- D. Cover the burns with dry gauze.
Correct Answer: A
Rationale: Fluid resuscitation is the priority to prevent hypovolemic shock in extensive burns.
The nurse assesses a client with a diagnosis of rib fractures to identify the risk for potential complications. The nurse notes that the client has a history of emphysema. After the assessment, the nurse ensures that which interventions are documented in the plan of care? Select all that apply.
- A. Maintain the client in a position of comfort.
- B. Collect sputum specimens at the hour of sleep.
- C. Offer medication to suppress the cough as needed.
- D. Administer small, frequent meals with plenty of fluids.
- E. Have the client cough and breathe deeply 20 minutes after pain medication is given.
- F. Administer 4 to 6 liters of oxygen when the client's pulse oximetry drops below 90%.
Correct Answer: A,D,E
Rationale: Clients with a diagnosis of rib fractures need interventions focused on their ability to maintain an effective breathing pattern and support the body in the healing process. Breathing effort is supported when the client is maintained in a comfortable position. Giving the client small frequent meals with plenty of fluids prevents the client from doing too much eating activity at one time and provides hydration to keep sputum liquefied for easier expectoration. Giving the client prescribed pain medication first and then having the client cough and deep breathe will encourage the client to complete these actions while limiting the amount of pain from doing them. If sputum specimen collection is prescribed, the specimen should be collected early in the morning upon the client's awakening. Clients with emphysema are not given cough suppressants because expectoration of sputum is essential to airway clearance. Giving the client with emphysema a high flow of oxygen could halt the hypoxic drive and cause apnea. A prescription is needed for changes in the oxygen flow.
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). The nurse should teach the client to avoid which of the following foods?
- A. Green leafy vegetables.
- B. Citrus fruits.
- C. Whole grains.
- D. Lean meats.
Correct Answer: A
Rationale: Green leafy vegetables are high in vitamin K, which can reduce warfarin's anticoagulant effect.