Nokea
A client is brought to the ED by ambulance in cardiac arrest with cardiopulmonary resuscitation (CPR) in progress. The client is intubated and is receiving 100% oxygen per self-inflating (ambu) bag. The nurse determines that the client is cyanotic, cold, and diaphoretic. Which assessment is most important for the nurse to obtain?
- A. Breath sounds over bilateral lung fields.
- B. Carotid pulsation during compressions
- C. Deep tendon reflexes
- D. Core body temperature
Correct Answer: A
Rationale: Assessing breath sounds ensures that the endotracheal tube is properly placed and that ventilation is effective, which is critical in a cardiac arrest situation.
You may also like to solve these questions
Regarding malaria:
- A. Plasmodium ovale has an exoerythrocytic cycle
- B. Plasmodium malariae does not occur after 5 years of primary illness
- C. Chloroquine is useful for prophylaxis of falciparum malaria in all areas of the world
- D. Primaquine is used to eradicate falciparum malaria
Correct Answer: A
Rationale: Plasmodium ovale has both an exoerythrocytic (liver) and erythrocytic (blood) cycle, which is a characteristic of this species of malaria parasite.
The following drugs are contraindicated in renal failure:
- A. Nitrofurantoin
- B. Carbamazepine
- C. Salbutamol
- D. Metolazone
Correct Answer: A
Rationale: Nitrofurantoin is contraindicated in renal failure due to the risk of accumulation and subsequent toxicity, as the kidneys are unable to excrete the drug effectively.
A nurse assesses a client who is scheduled for a cardiac catheterization. Which assessment should the nurse complete before this procedure?
- A. Client’s level of anxiety
- B. Ability to turn self in bed
- C. Cardiac rhythm and heart rate
- D. Allergies to iodine-based agents
Correct Answer: D
Rationale: Assessing for allergies to iodine-based agents is critical before cardiac catheterization, as contrast dye used during the procedure may cause an allergic reaction.
The nurse is evaluating a male client’s understanding of diet teaching about the DASH (Dietary Approaches to Stop Hypertension) eating plan. Which behavior indicates that the client is adhering to the eating plan?
- A. Uses only lactose-free dairy products
- B. Enjoys fat free yogurt as an occasional snack food
- C. No longer includes grains in his daily diet
- D. Carefully cleans and peels all fresh fruit and vegetables
Correct Answer: D
Rationale: Cleaning and peeling fruits and vegetables is consistent with the DASH plan, which promotes a high intake of fresh produce.
A male client who had abdominal surgery 5 days ago, and hospitalized because of a surgical wound infection, tells the nurse that he feels like his insides just spilled out when he coughed. What action should the nurse take first?
- A. Notify the healthcare provider
- B. Assure the client that such feelings occur with wound infections
- C. Visualize the abdominal incision
- D. Obtain sterile towels soaked in saline
Correct Answer: C
Rationale: Visualizing the incision helps determine if dehiscence or evisceration has occurred, which requires immediate intervention.