Nokea
A nurse obtained a client's pulse and found the rate to be above normal. The nurse documents this finding as:
- A. Tachypnea
- B. Hyperpyrexia
- C. Arrhythmia
- D. Tachycardia
Correct Answer: D
Rationale: When a nurse finds a client's pulse rate to be above normal, it is documented as tachycardia. Tachycardia specifically refers to an elevated heart rate, while tachypnea is rapid breathing, hyperpyrexia is high fever, and arrhythmia is an irregular heartbeat. Therefore, the correct term to describe an above-normal pulse rate is tachycardia.
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What is the best description of resonance?
- A. Sounds created by air-filled lungs
- B. Short, high-pitched, and thudding
- C. Moderately loud with a musical quality
- D. Drum-like
Correct Answer: A
Rationale: Resonance refers to the quality of sound produced by vibrations that are reinforced by other vibrations of the same frequency. In the context of the human body, resonance is often associated with sounds produced by air-filled structures like the lungs, vocal cords, and resonating cavities. Therefore, the best description of resonance from the given options is 'Sounds created by air-filled lungs.' This choice aligns with the concept of resonance as it relates to sound production in the human body.
For administering a cleansing enema, what is the common position typically used?
- A. Sims left lateral
- B. Dorsal Recumbent
- C. Supine
- D. Prone
Correct Answer: A
Rationale: The correct position for administering a cleansing enema is the Sims left lateral position. This position is preferred as it helps to facilitate the procedure by allowing gravity to assist in the flow of the enema solution. The individual lies on their left side with the right knee flexed towards the chest, which helps to promote retention of the enema solution and its distribution throughout the colon.
The healthcare professional prepares to administer buccal medication. The medicine should be placed...
- A. On the client's skin
- B. Between the client's cheeks and gums
- C. Under the client's tongue
- D. On the client's conjunctiva
Correct Answer: B
Rationale: Buccal medication is administered by placing it between the client's cheeks and gums. This route allows for the medication to be absorbed through the mucous membranes in the mouth, providing a rapid onset of action compared to oral ingestion. Placing the medication under the tongue (sublingual) allows for absorption through the sublingual mucosa, not the buccal mucosa. Placing medication on the skin or the conjunctiva is not appropriate for buccal administration.
How many drops are equivalent to 1 tsp?
- A. 15
- B. 60
- C. 10
- D. 30
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
What is the most appropriate nursing order for a patient who develops dyspnea and shortness of breath?
- A. Maintain the patient on strict bed rest at all times
- B. Maintain the patient in an orthopneic position as needed
- C. Administer high-flow oxygen immediately
- D. Encourage the patient to engage in vigorous physical activity
Correct Answer: B
Rationale: Maintaining the patient in an orthopneic position as needed is the most appropriate nursing order for a patient experiencing dyspnea and shortness of breath. This position helps to optimize lung expansion, improve oxygenation, and alleviate breathing difficulties. It is a strategic intervention to enhance respiratory function in patients with respiratory distress.