Nokea
After bronchoscopy, the nurse's priority is to check which of the following before feeding?
- A. Gag reflex
- B. Wearing off of anesthesia
- C. Swallowing reflex
- D. Peristalsis
Correct Answer: A
Rationale: After a bronchoscopy procedure, the nurse's priority is to check the patient's gag reflex before allowing them to eat to prevent aspiration. The gag reflex helps protect the airway by triggering a cough or gag response if something touches the back of the throat. This is crucial to ensure that the patient can protect their airway and prevent food or fluids from entering the lungs, especially when the throat may be sensitive or compromised post-bronchoscopy. Checking for the wearing off of anesthesia, swallowing reflex, or peristalsis are important assessments but not the immediate priority before feeding in this context.
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Which of the following best describes Primary Nursing?
- A. Assigning a nurse to lead a team of registered nurses in the care of a patient from admission to discharge
- B. Assigning a nurse to perform administrative tasks in a healthcare setting
- C. Assigning a nurse to provide medical treatment without supervision
- D. Assigning a nurse to be the main caregiver responsible for coordinating all aspects of care for a group of patients
Correct Answer: A
Rationale: Primary Nursing involves assigning a dedicated nurse to lead a team of registered nurses in the care of a patient from admission to discharge. This approach ensures continuity and personalized care. Choices B and C are incorrect as they do not accurately describe Primary Nursing. Choice D is incorrect as it refers to a different care delivery model.
What is the most appropriate instruction to provide to the parent of a child who does not like a food item?
- A. The child should not be encouraged to try it again.
- B. The child should be offered a reward if they eat most of the food items.
- C. The child should be offered the item at least 8 times on different occasions.
- D. The child should be encouraged to eat at least 5 bites of the food item.
Correct Answer: C
Rationale: The correct answer is C. Encouraging repeated exposure to the food item can help the child develop a taste for it. Option A is incorrect as it suggests avoiding encouraging the child to try the food again, which may hinder their ability to develop a liking for it. Option B is incorrect as using rewards for eating may not promote a genuine interest in the food item. Option D is incorrect because setting a specific number of bites may create pressure and negativity around mealtime, rather than fostering a positive association with the food.
Which statement indicates understanding of a low-fiber diet?
- A. I can cut up carrots and celery sticks for my lunch.
- B. I will eat a bran muffin for my mid-morning snack.
- C. I will have oatmeal with skim milk for my breakfast.
- D. I should choose canned peaches for my fruit serving.
Correct Answer: D
Rationale: The correct answer is D because canned peaches are low in fiber compared to the other options provided. Option A contains high-fiber vegetables (carrots and celery), option B includes a bran muffin which is fiber-rich, and option C involves oatmeal which is also a good source of fiber. Therefore, choosing canned peaches aligns with a low-fiber diet.
The nurse is caring for a client taking warfarin. Which meal brought in by the client's family is a priority to remove before the client eats it?
- A. Oriental cabbage salad with chicken
- B. Beef enchilada, rice, and beans
- C. Ham and cheese sandwich
- D. Macaroni salad and grapefruit slices
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case?
- A. Instruct the client to observe strict bed rest
- B. Check for epidural catheter drainage
- C. Administer analgesia through the epidural catheter as prescribed
- D. Assess respiratory rate carefully
Correct Answer: D
Rationale: The nursing priority care in a case where an epidural catheter for Fentanyl epidural analgesia is given during hip surgeries is to assess the respiratory rate carefully. Respiratory depression is a potential side effect of Fentanyl, especially when administered epidurally. Monitoring the respiratory rate is crucial to detect any signs of respiratory distress promptly. Instructing the client to observe strict bed rest (Choice A) may be necessary but is not the priority over ensuring respiratory function. Checking for epidural catheter drainage (Choice B) and administering analgesia through the epidural catheter as prescribed (Choice C) are important aspects of care, but ensuring adequate ventilation takes precedence to prevent complications.