Nokea
A client with pancreatitis is admitted with severe abdominal pain. Which position should the nurse encourage to reduce discomfort?
- A. Supine with legs elevated
- B. Side-lying with knees flexed
- C. Prone with a pillow under the abdomen
- D. Sitting upright
Correct Answer: B
Rationale: Side-lying with knees flexed reduces tension on the abdominal muscles and pancreas, helping to alleviate pain in pancreatitis.
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When a client has a tearing of tissue with irregular wound edges, the nurse should document this as:
- A. Contusion
- B. Abrasion
- C. Laceration
- D. Colonization
Correct Answer: C
Rationale: A laceration is characterized by tearing of tissue with irregular wound edges. Contusions are bruises, abrasions are superficial, and colonization refers to bacterial presence, not wound type.
A client is admitted to the hospital with the diagnosis of Cushing's disease. The nurse should monitor the client's laboratory studies for which associated disorder?
- A. Hypokalemia
- B. Hyperglycemia
- C. Decreased plasma cortisol levels
- D. Low white blood cell (WBC) count
Correct Answer: B
Rationale: The client with adrenocorticosteroid excess experiences hyperglycemia, hyperkalemia, elevated plasma cortisol and adrenocorticotropic hormone (ACTH) levels, and an elevated WBC count. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids on the body.
A client with a diagnosis of Tourette's syndrome is receiving haloperidol decanoate. The registered nurse asks the new nurse to describe the action of the medication. The new nurse responds correctly by stating that this medication has which action?
- A. Is a serotonin reuptake blocker
- B. Inhibits the breakdown of released acetylcholine
- C. Blocks the uptake of norepinephrine and serotonin
- D. Blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain
Correct Answer: D
Rationale: Haloperidol decanoate is a typical antipsychotic medication used to manage symptoms of Tourette's syndrome, such as tics, by blocking the binding of dopamine to postsynaptic dopamine receptors in the brain, thereby reducing dopaminergic activity. It does not act as a serotonin reuptake blocker, inhibit acetylcholine breakdown, or block norepinephrine and serotonin uptake.
The nurse tells a rape victim that even if she was protected against pregnancy by a contraceptive and the attention of taking any legal action against her assailant, she should still be checked by a physician for early detection of which of the following?
- A. Sexually transmitted disease.
- B. Anxiety reaction.
- C. Periurethral tears.
- D. Menstrual difficulties.
Correct Answer: A
Rationale: A physician should check for sexually transmitted diseases, as rape increases the risk of infection, which requires early detection and treatment.
The nurse is preparing to administer a blood transfusion. Which solution should be used to prime the tubing?
- A. Dextrose 5% in water.
- B. Lactated Ringer's.
- C. 0.9% sodium chloride.
- D. Heparinized saline.
Correct Answer: C
Rationale: 0.9% sodium chloride is compatible with blood products and used to prime tubing to prevent hemolysis.