Nokea
A nurse is preparing to administer a nasogastric (NG) tube feeding for a patient. What action should the nurse prioritize before initiating tube feeding?
- A. Verifying the NG tube placement by auscultating for bowel sounds
- B. Securing the NG tube to prevent dislodgement during feeding
- C. Checking the patency of the NG tube by aspirating gastric contents
- D. Elevating the head of the bed to a semi-Fowler's position
Correct Answer: C
Rationale: The nurse should prioritize checking the patency of the NG tube by aspirating gastric contents before initiating tube feeding. This is important to ensure that the NG tube is in the correct position and that it is functioning properly. By aspirating gastric contents, the nurse can confirm that the tube is in the stomach and not in the lungs or surrounding tissues. If no gastric contents are obtained upon aspiration, it may indicate that the tube is not properly placed or may be occluded, which would require further assessment and intervention before proceeding with tube feeding. Checking the patency of the NG tube is a crucial step in ensuring the safety and effectiveness of enteral nutrition delivery.
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A patient presents with recurrent episodes of fever, sore throat, and cervical lymphadenopathy. Laboratory tests reveal leukocytosis with atypical lymphocytes on peripheral blood smear and positive heterophile antibody test (Monospot test). Which of the following conditions is most likely to cause these findings?
- A. Infectious mononucleosis (Epstein-Barr virus infection)
- B. Cytomegalovirus (CMV) infection
- C. HIV/AIDS
- D. Toxoplasmosis
Correct Answer: A
Rationale: The clinical presentation of recurrent fever, sore throat, cervical lymphadenopathy, leukocytosis with atypical lymphocytes, and positive heterophile antibody test (Monospot test) is highly indicative of infectious mononucleosis caused by the Epstein-Barr virus (EBV). EBV is a member of the herpesvirus family and is a common cause of infectious mononucleosis. The atypical lymphocytes seen on peripheral blood smear are reactive T lymphocytes responding to the EBV infection. The Monospot test detects heterophile antibodies produced in response to EBV infection.
In this pandemic nurses are float to areas of most need in the time of a nursing shortage, this is an example of:
- A. Utilitarianism theory
- B. Justice
- C. Deontological theory
- D. Beneficence
Correct Answer: A
Rationale: Utilitarianism is an ethical theory that focuses on producing the greatest overall balance of good over bad consequences for everyone involved. In the context of the situation described, nurses being floated to areas of most need during a nursing shortage is an example of utilitarianism in action. The decision to float nurses is aimed at maximizing the benefit to the greatest number of patients by ensuring that critical care is provided where it is most needed, even if it may cause inconvenience or discomfort to the nurses being floated. This decision aligns with the principle of maximizing overall utility and promoting the greater good, which are central tenets of utilitarianism.
What isotonic electrolyte solutions are COMMONLY used as fluid replacement in hypovolemic shock? I. Dextrose 5 percent in water II. 0.9 percent sodium chloride III. Lactated Ringer's solution IV. Dextrose 10 percent in water
- A. II, III, and IV
- B. II and III
- C. I, III, and IV
- D. I and IV
Correct Answer: B
Rationale: In hypovolemic shock, isotonic electrolyte solutions are commonly used for fluid replacement to restore the circulating blood volume. The commonly used isotonic electrolyte solutions for this purpose are 0.9% sodium chloride (normal saline) and lactated Ringer's solution.
You cannot open Claudia's eyes due to dried crust. Which of the following actions would you do?
- A. Apply the eye drops the next day
- B. Apply eye ointment to soften the crust
- C. Instill eye drops
- D. Place a warm wet wash cloth over her eyes for at least three minutes
Correct Answer: D
Rationale: The best course of action in this scenario is to place a warm wet washcloth over Claudia's eyes for at least three minutes. This will help soften and loosen the dried crust, making it easier to gently clean her eyes and open them. Applying eye drops or ointment may not be effective if the crust is blocking her eyes completely. By using a warm wet washcloth, you can improve the ability to clean her eyes effectively and without causing discomfort.
While you are doing your physical assessment to patent Aster, she has been exhibiting a UNIQUE clinical manifestation different from patients Claire and Sonia which is characterized by________.
- A. Cyanosis, increasing growth of hands and feet
- B. anemia, weight 1oss and presence of
- C. moon facies, purple striae on trunk and buffalo hump
- D. moon facies, easy fatigability and peripheral edema
Correct Answer: A
Rationale: The clinical manifestations of Aster suggest acromegaly, a condition characterized by the excessive growth of hands and feet due to a tumor in the pituitary gland leading to overproduction of growth hormone. Cyanosis is a bluish discoloration of the skin caused by poor oxygenation, which is not typically associated with acromegaly. The other options do not match the unique clinical manifestation described for Aster. Anemia, weight loss, moon facies, and edema are more commonly associated with other conditions like Cushing's syndrome, anemia, or heart failure.