A nurse is teaching about the energy needed at rest to maintain life-sustaining activities for a specific period of time. What is the nurse discussing?
- A. Resting energy expenditure (REE)
- B. Basal metabolic rate (BMR)
- C. Nutrient density
- D. Nutrients
Correct Answer: B
Rationale: The correct answer is B: Basal metabolic rate (BMR). BMR refers to the minimum amount of energy required to maintain basic physiological functions at rest. It accounts for about 60-75% of total energy expenditure. It is essential for sustaining life-sustaining activities such as breathing, circulating blood, and maintaining body temperature.
Incorrect Choices:
A: Resting energy expenditure (REE) is the total amount of energy expended by the body while at rest, including BMR and additional energy for daily activities.
C: Nutrient density refers to the amount of nutrients per calorie in a food item, not the energy needed at rest.
D: Nutrients are essential substances in food required for growth, maintenance, and repair, but they do not specifically refer to the energy needed at rest.
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The nurse on the medicalsurgical unit is reviewing discharge instructions with a patient who has a history of glaucoma. The nurse should anticipate the use of what medications?
- A. Potassium-sparing diuretics
- B. Cholinergics
- C. Antibiotics
- D. Loop diuretics
Correct Answer: B
Rationale: The correct answer is B: Cholinergics. Glaucoma is a condition characterized by increased intraocular pressure due to impaired drainage of aqueous humor. Cholinergics help to constrict the pupil and improve the outflow of aqueous humor, thus reducing intraocular pressure. This medication class is commonly used to manage glaucoma.
A: Potassium-sparing diuretics are not typically used in the treatment of glaucoma. They are mainly used to manage conditions like hypertension and heart failure.
C: Antibiotics are not indicated for the routine management of glaucoma. They are used to treat infections.
D: Loop diuretics are not commonly used in the treatment of glaucoma. They are primarily used to manage conditions like edema and hypertension.
A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis?
- A. Administration of the measles-mumps-rubella (MMR) vaccine
- B. Rapid administration of intravenous fluids
- C. Computed tomography with contrast solution
- D. Administration of nebulized bronchodilators
Correct Answer: C
Rationale: The correct answer is C: Computed tomography with contrast solution. This procedure involves the use of contrast agents that can trigger anaphylaxis due to the patient's allergic reaction to the contrast solution. Contrast solutions contain substances like iodine, which can cause severe allergic reactions in some individuals. Anaphylaxis is a life-threatening allergic reaction that can occur rapidly and requires immediate intervention. Assessing the risk for anaphylaxis during this procedure is crucial to prevent any potential harm to the patient.
Incorrect choices:
A: Administration of the measles-mumps-rubella (MMR) vaccine - While allergic reactions can occur with vaccines, the risk of anaphylaxis with MMR vaccine is lower compared to the contrast solution used in CT scans.
B: Rapid administration of intravenous fluids - Rapid IV fluid administration can cause fluid overload or electrolyte imbalances, but it is not typically associated with triggering anaphylaxis.
D: Administration of nebulized bronchodil
A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.
- A. Financial pressures on health care providers
- B. Patient reluctance to accept this type of care
- C. Strong association of hospice care with prolonging death
- D. Advances in curative treatment in late-stage illness E) Ease of making a terminal diagnosis
Correct Answer: A
Rationale: The correct answer is A: Financial pressures on health care providers. Physicians may be reluctant to refer patients to hospice care due to financial pressures. This could be because hospice care may be seen as less profitable compared to other treatments or services. Other choices are incorrect because: B: Patient reluctance is not a contributing factor from the physician's perspective. C: Hospice care is actually focused on comfort and quality of life, not prolonging death. D: Advances in curative treatment may not be directly related to physician reluctance to refer to hospice. E: Ease of making a terminal diagnosis is not a significant factor influencing physician reluctance.
After providing care, a nurse charts in the patient’srecord. Which entry will the nurse document?
- A. Appears restless when sitting in the chair
- B. Drank adequate amounts of water
- C. Apparently is asleep with eyes closed
- D. Skin pale and cool
Correct Answer: D
Rationale: The correct answer is D because documenting the skin condition is an objective assessment that provides vital information about the patient's health status. Pale and cool skin may indicate poor perfusion or circulation issues. This observation is crucial for monitoring the patient's condition and identifying any potential concerns. Choices A, B, and C are subjective and do not provide specific or relevant information related to the patient's overall health status or response to care. Without objective data like skin appearance, it would be challenging to assess the patient's condition accurately.
The patient has just been started on an enteral feeding and has developed diarrhea after being on the feeding for 2 hours. What does the nurse suspect is themostlikely cause of the diarrhea?
- A. Antibiotic therapy
- B. Clostridium difficile
- C. Formula intolerance
- D. Bacterial contamination
Correct Answer: C
Rationale: The correct answer is C: Formula intolerance. When a patient develops diarrhea shortly after starting enteral feeding, formula intolerance is the most likely cause. This can occur due to the patient's inability to tolerate certain ingredients in the formula, leading to gastrointestinal upset. Antibiotics (choice A) and Clostridium difficile (choice B) typically take longer to cause diarrhea. Bacterial contamination (choice D) would usually result in more severe symptoms beyond just diarrhea. In this scenario, formula intolerance is the most logical explanation for the immediate onset of diarrhea after starting enteral feeding.