Nokea
A client is vomiting. Which of the following actions should the nurse take first?
- A. Provide the client with an emesis basin
- B. Notify housekeeping
- C. Prevent the client from aspirating
- D. Administer an antiemetic to the client
Correct Answer: C
Rationale: The correct action for the nurse to take first is to prevent the client from aspirating. Aspiration is a serious risk when a client is vomiting as it can lead to respiratory complications. The nurse should position the client on their side to prevent aspiration of vomitus into the airway. This immediate action takes priority over providing an emesis basin, notifying housekeeping, or administering an antiemetic, which do not address the urgent need to prevent aspiration.
You may also like to solve these questions
9. When the family members of a postoperative patient leave after a visit, the patient tells the nurse that his family gave him a headache by fussing over him so much. What is an appropriate intervention by the nurse?
- A. Administer the PRN analgesic prescribed for his postoperative pain.
- B. Ask the patient’s permission to use acupressure to ease his headache.
- C. Reassure the patient that his headache will subside now that his family has gone.
- D. Teach the patient biofeedback methods to relieve his headaches by controlling cerebral blood flow.
Correct Answer: B
Rationale: Asking the patient’s permission to use acupressure (option B) is an appropriate non-pharmacological intervention that respects patient autonomy and may effectively alleviate the headache.
Which of the following is a finding that is most often associated with endometrial cancer?
- A. Thickened endometrial lining on ultrasound
- B. Irregular periods
- C. Young age
- D. Dyspareunia
Correct Answer: A
Rationale: A thickened endometrial lining on ultrasound is commonly associated with endometrial cancer, indicating abnormal cell growth.
A healthcare professional is preparing to administer albuterol syrup 1.6 mg PO tid. Available is albuterol 2 mg/5mL. How many mL should the healthcare professional administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
- A. 4 mL
- B. 6 mL
- C. 10 mL
- D. 5.5 mL
Correct Answer: A
Rationale: To determine the mL per dose of albuterol syrup, we need to calculate how many mL contain 1.6 mg of albuterol. Given that 2 mg of albuterol is in 5 mL of syrup, we can set up a proportion:
2 mg / 5 mL = 1.6 mg / x mL
Cross-multiply to solve for x:
2 * x = 1.6 * 5
2x = 8
x = 4 mL
Therefore, the correct answer is A: 4 mL.
Choice B (6 mL) is incorrect because it does not match the calculated value. Choice C (10 mL) is incorrect as it is too high based on the calculation. Choice D (5.5 mL) is incorrect as it does not match the precise calculated value of 4 mL.
Patients with a paralytic ileus typically have
- A. Intravenous fluid replacement and a nasogastric tube connected to suction.
- B. Surgical correction of the problem.
- C. Endoscopic injection of botulinum toxin or esophageal dilation.
- D. Endoscopy to allow biopsy followed with broad-spectrum antibiotics.
Correct Answer: A
Rationale: Paralytic ileus requires decompression of the gastrointestinal tract.
End-of-life palliative nursing care involves
- A. Constant assessment for changes in physiologic functioning.
- B. Administering large doses of analgesics to keep the patient sedated.
- C. Providing as little physical care as possible to prevent disturbing the patient.
- D. Encouraging the patient and family members to verbalize their feelings of sadness
Correct Answer: D
Rationale: Emotional and psychological support for both the patient and family is crucial in palliative care, helping them process feelings and find closure.