Nokea
A female client who received partial-thickness and full-thickness burns over 40% of her body in a house fire is admitted to the inpatient burn unit. What fluid should the nurse prepare to administer during the acute phase of the client's burn recovery?
- A. Ringer's Lactate
- B. Normal Saline.
- C. Dextrose 5% in water (D5W)
- D. Hypertonic saline
Correct Answer: A
Rationale: Ringer's Lactate is the preferred fluid for burn resuscitation, as it helps maintain electrolyte balance and fluid volume.
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The nurse calculates the body mass index (BMI) for an obese adult. Which additional assessment finding places the client at high risk for cardiac disease?
- A. Large waist circumference with central fat
- B. High serum insulin level
- C. Hyperpigmentation on neck skin folds
- D. Poor muscle tone
Correct Answer: A
Rationale: A large waist circumference with central fat is associated with an increased risk for cardiac disease due to visceral fat accumulation.
The following are major side effects of PGE1 EXCEPT
- A. apnea
- B. fever
- C. cutaneous flushing
- D. hypertension
Correct Answer: D
Rationale: Cutaneous flushing is a common side effect of PGE1, while hypertension is not typically observed.
The vast majority of tumors originating from the heart are benign. Of the following, the MOST common pediatric cardiac tumors are
- A. fibromas
- B. rhabdomyomas
- C. myxomas
- D. hemangiomas
Correct Answer: B
Rationale: Rhabdomyomas are the most common benign cardiac tumors in children.
During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to:
- A. Lay the child flat to promote hemostasis
- B. Lay the child flat with legs elevated to increase blood flow to the heart
- C. Sit the child on the parent's lap, with legs dangling, to promote venous pooling
- D. Hold the child in knee-chest position to decrease venous blood return
Correct Answer: D
Rationale: The knee-chest position increases systemic vascular resistance (SVR), which increases blood flow to the pulmonary artery.
A male client with Herpes zoster (shingles) on his thorax tells the nurse that he is having difficulty sleeping. What is the probable etiology of this problem?
- A. Pain
- B. Nocturia
- C. Dyspnea
- D. Frequent cough
Correct Answer: A
Rationale: Pain from shingles can be severe and interfere with sleep, making it the most likely cause of the client's difficulty sleeping.