Nokea
A nurse is admitting a client with a history of duodenal ulcer. To determine if the client's current symptoms are related to this information, the nurse should assess the client for which manifestations of a duodenal ulcer?
- A. Pain relieved by food intake
- B. Pain radiating down the right arm
- C. Nausea and vomiting
- D. Weight loss
Correct Answer: A
Rationale: Pain relief after eating is characteristic of duodenal ulcers as food neutralizes gastric acid temporarily.
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The nurse would be most concerned about a prescription for a lipid emulsion for a client with which condition?
- A. Fractured femur
- B. Severe anorexia nervosa
- C. Gastrointestinal obstruction
- D. Chronic diarrhea and vomiting
Correct Answer: C
Rationale: Gastrointestinal obstruction contraindicates lipid emulsion administration as it could worsen the obstruction.
A client presents with a possible bowel obstruction, and the nurse completes a detailed abdominal assessment. Which of the following clinical manifestations are consistent with a large bowel obstruction? (Select all that apply).
- A. Profuse vomiting with fecal odor
- B. Epigastric abdominal distention
- C. Intermittent abdominal cramping
- D. Ribbon-like stools or diarrhea
- E. Metabolic acidosis
- F. Severe fluid and electrolyte imbalance
Correct Answer: A,B,C,D,E,F
Rationale: All are potential findings in LBO due to mechanical obstruction, bacterial overgrowth, and fluid shifts.
A nurse is teaching a client about self-administering peritoneal dialysis. Which of the following statements by the client indicates a need for further teaching?
- A. The microwave in my kitchen can warm the solution before I use it.
- B. The catheter can become infected even with sterile precautions.
- C. The volume of the output solution should be greater than the input solution.
- D. The fluid from my abdomen will be clear or slightly yellow.
Correct Answer: A
Rationale: Microwaving can unevenly heat solution and is not recommended; solutions should be warmed using approved methods.
A nurse is planning care for a client who has undergone cardiac catheterization through the femoral artery. Which of the following actions should the nurse plan to take?
- A. Instruct the client to perform range-of-motion exercises to his lower extremities.
- B. Ambulate the client 1 hour following the procedure.
- C. Restrict the client's fluid intake.
- D. Assess the color, temperature, and pulse in the affected extremity.
Correct Answer: D
Rationale: Assessing the extremity monitors for vascular complications like bleeding or occlusion post-catheterization.
The client is scheduled to receive 30 grams of lactulose orally every 12 hours. An oral solution containing 5 g/10 mL is available. How many mL should be poured into the medication cup to administer the required dose?
Correct Answer: 60
Rationale: Calculation: (30 g ÷ 5 g) × 10 mL = 60 mL