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A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?
- A. Obtain another antihypertensive prescription to avoid withdrawal symptoms.
- B. Stop the medication and keep an accurate record of blood pressure.
- C. Report any uncomfortable symptoms after stopping the medication.
- D. Ask the healthcare provider about tapering the drug dose over the next week.
Correct Answer: D
Rationale: The correct answer is D: Ask the healthcare provider about tapering the drug dose over the next week. This answer is correct because propranolol is a beta-blocker, and abrupt discontinuation can lead to rebound hypertension, angina, or even myocardial infarction due to the sudden withdrawal of the medication. Tapering the drug dose over time allows the body to adjust gradually and reduces the risk of these adverse effects.
Choice A is incorrect because obtaining another antihypertensive prescription is not necessary if the client's blood pressure has been normal for the past three months. Choice B is incorrect because abruptly stopping the medication without tapering can lead to withdrawal symptoms. Choice C is incorrect because simply reporting uncomfortable symptoms without taking appropriate action (tapering the drug dose) is not addressing the potential risks associated with abrupt discontinuation of propranolol.
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Which statement is true regarding oral care for the prevention of ventilator-associated pneumonia (VAP)? (Select all that apply.)
- A. Tooth brushing is performed every 2 hours for the greatest effect.
- B. Implementing a comprehensive oral care program is an intervention for preventing WWW .THENURSINGMASTERY.COM VAP.
- C. Oral care protocols should include oral suctioning and brushing teeth.
- D. Protocols that include chlorhexidine gluconate have beaebnirb e.cfofme/ctetsivt e in preventing VAP.
Correct Answer: B
Rationale: The correct answer is B. Implementing a comprehensive oral care program is an intervention for preventing VAP. This statement is true because proper oral care, including brushing teeth, oral suctioning, and using chlorhexidine gluconate, has been shown to reduce the risk of VAP by decreasing the colonization of pathogenic bacteria in the oral cavity. Regular oral care helps maintain oral hygiene and reduce the risk of aspiration of bacteria into the lungs, which is a common cause of VAP.
Incorrect Answer Analysis:
A: Tooth brushing every 2 hours may be excessive and could potentially cause harm to the oral mucosa, leading to increased risk of infection.
C: While oral suctioning and brushing teeth are important components of oral care, the statement is not comprehensive enough to address the full range of interventions needed to prevent VAP.
D: While chlorhexidine gluconate can be effective in preventing VAP, the statement implies that it is the only effective intervention, which is not true.
assessment, the patient is restless, heart rate has increased to 110 beats/min, respirations are 36 breaths/min, and blood pressure is 156/98 mm Hg. The cardiac monitor shows sinaubsir bt.acocmh/ytecsat rdia with 10 premature ventricular contractions (PVCs) per minute. Pulmonary artery pressures are elevated. The nurse suctions the patient and obtains pink, frothy secretio ns. Loud crackles are audible throughout lung fields. The nurse notifies the physician, w ho orders an ABG analysis, electrolyte levels, and a portable chest x-ray study. How d oes the nurse interpret the following blood gas levels? pH 7.28 PaCO 46 mm Hg Bicarbonate 22 mEq/L PaO 58 mm Hg O saturation 88% 2
- A. Hypoxemia and compensated respiratory alkalosis
- B. Hypoxemia and uncompensated respiratory acidosis
- C. Normal arterial blood gas levels
- D. Normal oxygen level and partially compensated metabaobliribc.c aomci/dteosts is
Correct Answer: B
Rationale: The correct answer is B: Hypoxemia and uncompensated respiratory acidosis.
Step-by-step rationale:
1. pH is low (7.28), indicating acidosis.
2. PaCO2 is elevated (46 mm Hg), indicating respiratory acidosis.
3. PaO2 is low (58 mm Hg), indicating hypoxemia.
4. Bicarbonate is within normal range (22 mEq/L), suggesting no compensation for the acidosis.
5. Oxygen saturation is low (88%), supporting the presence of hypoxemia.
Summary:
A: Incorrect - pH is low, not indicating compensated alkalosis.
C: Incorrect - Various abnormalities in the blood gas levels are present.
D: Incorrect - There is hypoxemia and uncompensated acidosis, not metabolic alkalosis.
Which patient should the nurse refer for hospice care?
- A. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying.
- B. A 72-year-old with chronic severe pain due to spinal arthritis and vertebral collapse.
- C. A 28-year-old with AIDS-related dementia who needs palliative care and pain management.
- D. A 56-year-old with advanced liver failure whose family members can no longer provide care in the home.
Correct Answer: C
Rationale: The correct answer is C because the patient with AIDS-related dementia requires palliative care and pain management, which are key components of hospice care. This patient is likely in the terminal stage of their illness and would benefit from the comprehensive support provided by hospice services.
Choice A is incorrect because the patient's children's inability to discuss dying issues does not necessarily indicate a need for hospice care. Choice B is incorrect as chronic severe pain due to spinal arthritis is not a sole criterion for hospice referral. Choice D is incorrect as advanced liver failure alone does not automatically qualify a patient for hospice care.
A normal urine output is considered to be
- A. 80 to 125 mL/min.
- B. 180 L/day.
- C. 80 mL/min.
- D. 1 to 2 L/day.
Correct Answer: D
Rationale: The correct answer is D (1 to 2 L/day) because the average adult typically produces 1 to 2 liters of urine per day. This range is considered normal for maintaining proper hydration and eliminating waste products. Choice A (80 to 125 mL/min) is incorrect as it represents the rate of urine production per minute, which is not commonly used to measure daily urine output. Choice B (180 L/day) is unrealistic and far exceeds the normal range for urine output. Choice C (80 mL/min) is too low for daily urine output and would not be sufficient for adequate waste elimination.
The nurse is assessing an older client and determines that the client's left upper eyelid droops, covering more of the iris than the right eyelid. Which description should the nurse use to document this finding?
- A. A nystagmus on the left.
- B. Exophthalmos on the right.
- C. Ptosis on the left eyelid.
- D. Astigmatism on the right.
Correct Answer: C
Rationale: The correct answer is C: Ptosis on the left eyelid. Ptosis refers to drooping of the eyelid, which is a common condition in older adults. In this scenario, the nurse should document the finding as ptosis on the left eyelid because the client's left upper eyelid is drooping, covering more of the iris than the right eyelid.
Explanation: Nystagmus (A) is an involuntary eye movement, not related to eyelid drooping. Exophthalmos (B) is the protrusion of the eyeball and not relevant to this scenario. Astigmatism (D) refers to a refractive error of the eye and does not cause eyelid drooping. Therefore, the correct choice is C as it accurately describes the client's condition.