Nokea
A client with cancer of the stomach has a gastric resection. The nurse should tell the client that following surgery:
- A. He can eat any type food he wants to eat.
- B. Proteins and vitamins will assist with healing.
- C. He will only be able to have high-calorie liquids.
- D. Increasing his fat intake will help promote healing.
Correct Answer: B
Rationale: Proteins and vitamins support tissue repair post-gastrectomy. Any food may cause dumping syndrome. High-calorie liquids are too restrictive. High fat delays gastric emptying.
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A nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease (COPD) and a history of type 2 diabetes mellitus requiring insulin. The client has been prescribed prednisone. The nurse anticipates which need?
- A. Close monitoring for hypotension
- B. Gradually increasing the prednisone dose
- C. Increasing the insulin dose
- D. Monitoring and recording intake and output
Correct Answer: C
Rationale: Prednisone increases blood glucose, necessitating a higher insulin dose in diabetes. Hypotension is not a primary concern, prednisone is not typically titrated upward, and intake/output monitoring is less critical.
The nurse monitors a child who has been treated for an acute asthma exacerbation. Which finding is the best indicator that treatment has been effective?
- A. Episodes of spasmodic coughing have decreased
- B. No wheezes are audible on chest auscultation
- C. Oxygen saturation has increased from 88% to 93%
- D. Peak expiratory flow rate has dropped from 212 L/min to 127 L/min
Correct Answer: B
Rationale: Absence of wheezes indicates open airways, the primary goal of asthma treatment. Reduced coughing and improved oxygen saturation are positive but less specific than clear lungs.
The nurse is planning care for a client who is taking cyclosporin (Neoral). What would be an appropriate nursing diagnosis for this client?
- A. Alteration in body image
- B. High risk for infection
- C. Altered growth and development
- D. Impaired physical mobility
Correct Answer: B
Rationale: Cyclosporin (Neoral) inhibits normal immune responses. Clients receiving cyclosporin are at risk for infection.
The nurse is reinforcing meal planning teaching to a group of clients with celiac disease. Which meal is appropriate for the nurse to include?
- A. Baked salmon with rice, steamed vegetables, and dinner roll
- B. Breaded pork chops, corn on the cob, and steamed snow peas
- C. Grilled chicken, green beans, and mashed potatoes
- D. Spaghetti with Italian tomato sauce and meatballs
Correct Answer: C
Rationale: Grilled chicken, green beans, and mashed potatoes are gluten-free, suitable for celiac disease. Dinner rolls, breaded pork chops, and spaghetti contain gluten, which must be avoided.
A primigravida arrives at the labor unit stating that she is having contractions. Which statement describes the presence of true contractions?
- A. True contractions begin in the lower abdomen.
- B. True contractions have a consistent frequency.
- C. True contractions lessen with physical activity.
- D. True contractions are inconsistent in frequency.
Correct Answer: B
Rationale: True contractions have a consistent frequency , becoming regular and stronger. They start in the back or upper abdomen (A is incorrect), intensify with activity (C is incorrect), and are regular (D is incorrect).