Nokea
A healthcare professional is planning to collect a stool specimen for ova and parasites from a client with diarrhea. Which of the following actions should the healthcare professional take when collecting the specimen?
- A. Instruct the client to defecate into a clean container
- B. Transfer the specimen to a sterile container
- C. Refrigerate the collected specimen
- D. Place the stool specimen collection container in a biohazard bag
Correct Answer: D
Rationale: When collecting a stool specimen for ova and parasites, it is essential to place the specimen collection container in a biohazard bag. This practice ensures proper handling of potentially infectious material and prevents contamination with microorganisms. The biohazard bag should be labeled with the client's information for easy identification and proper tracking throughout the testing process. Instructing the client to defecate into a clean container is incorrect as it may introduce contaminants. Transferring the specimen to a sterile container is unnecessary and can increase the risk of contamination. Refrigerating the collected specimen is also not recommended as it may alter the sample and affect the test results.
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Among the following statements, which should be given the HIGHEST priority?
- A. Client is in extreme pain
- B. Client's blood pressure is 60/40
- C. Client's temperature is 40 deg. Centigrade
- D. Client is cyanotic
Correct Answer: B
Rationale: BP 60/40 (B) is highest priority; severe hypotension threatens perfusion, per ABCs (circulation). Pain (A), fever (C), and cyanosis (D) are urgent but secondary to life-threatening shock. B demands immediate action, making it correct.
A client has a tracheostomy and requires suctioning. Which of the following actions should be taken?
- A. Hyperoxygenate the client before suctioning
- B. Insert the catheter while exhalation
- C. Apply suction after inserting the catheter
- D. Limit suctioning to no more than 15 seconds
Correct Answer: A
Rationale: Hyperoxygenating the client before suctioning is crucial to prevent hypoxia during the procedure. By using a manual resuscitation bag with 100% oxygen, the nurse should provide several breaths to the client to ensure sufficient oxygenation before starting suctioning. This approach helps maintain oxygen levels and decreases the risk of hypoxia, which may arise when suctioning interrupts the normal respiratory process. Choices B, C, and D are incorrect because inserting the catheter during exhalation, applying suction while inserting the catheter, and limiting suctioning to 15 seconds do not address the priority of hyperoxygenating the client to prevent hypoxia.
When administering an IM injection to a 5-month-old infant, which of the following injection sites should be used?
- A. Deltoid
- B. Ventrogluteal
- C. Vastus lateralis
- D. Dorsogluteal
Correct Answer: C
Rationale: For infants and young children, the vastus lateralis muscle located over the anterior thigh is the preferred site for intramuscular injections. This site is chosen for its large muscle mass and reduced risk of injury to major nerves and blood vessels. Infants have less developed muscle structures, making the vastus lateralis a safer and more effective site for injections compared to other sites like the deltoid, ventrogluteal, or dorsogluteal. Using the correct injection site is essential to prevent complications and ensure the proper absorption of the medication.
Indicate true or false: (Adapted: Which statement is true about IV solutions?)
- A. Hypotonic solutions should be replaced intracellular fluid loss.
- B. Smaller veins are ideal for intravenous solutions that are irritating.
- C. Both statements are true.
- D. Neither statement is true.
Correct Answer: A
Rationale: Hypotonic solutions (e.g., 0.45% saline) shift fluid into cells, replacing intracellular loss (e.g., dehydration), making this true ideal for cellular rehydration. Smaller veins aren't ideal for irritating solutions (e.g., potassium); larger veins dilute and tolerate them better, reducing phlebitis making this false. Adapting the true/false format, 'hypotonic solutions should replace intracellular loss' stands as true, supported by fluid dynamics in nursing. Both being true fails due to the vein statement. Neither true ignores the hypotonic role. The first statement's accuracy aligns with IV therapy principles, guiding nurses in fluid management, making it the correct choice.
A client with ulcerative colitis is receiving dietary management education from a healthcare provider. Which statement by the client indicates an understanding of the teaching?
- A. I should increase my intake of dairy products.
- B. I should decrease my intake of dairy products.
- C. I should increase my intake of high-fiber foods.
- D. I should decrease my intake of high-fat foods.
Correct Answer: B
Rationale: The correct answer is B because reducing dairy product intake can help manage symptoms of ulcerative colitis. Dairy products can exacerbate symptoms in some individuals due to their lactose content and may need to be limited or avoided based on individual tolerance levels. Choice A is incorrect because increasing dairy products can worsen symptoms for some ulcerative colitis patients. Choice C is incorrect as while high-fiber foods are generally beneficial, they may exacerbate symptoms during a flare-up. Choice D is also incorrect as while reducing high-fat foods can be beneficial, dairy products are a more specific concern for ulcerative colitis.