After cleaning the abrasions and applying antiseptic, the nurse applies a cold compress to the swollen ankle as ordered by the physician. This statement shows that the nurse has a correct understanding of the use of a cold compress:
- A. Cold compress reduces blood viscosity in the affected area
- B. It is safer to apply than a hot compress
- C. Cold compress prevents edema and reduces pain
- D. It eliminates toxic waste products due to vasodilation
Correct Answer: C
Rationale: The correct understanding of using a cold compress includes knowing that it helps prevent edema and reduces pain. Cold application constricts blood vessels, reducing blood flow to the area, which helps decrease swelling and pain. Choices A, B, and D are incorrect because cold compresses do not directly affect blood viscosity, safety compared to hot compresses, or eliminate toxic waste products due to vasodilation. It is essential for nurses to have a clear understanding of the rationale behind interventions to provide effective patient care.
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Which change during pregnancy is related to the slowing of the gastrointestinal tract?
- A. Diarrhea
- B. Constipation
- C. Decreased absorption of iron
- D. Decreased absorption of calcium
Correct Answer: B
Rationale: During pregnancy, the gastrointestinal tract tends to slow down, leading to constipation. This is due to hormonal changes that relax the intestinal muscles, allowing more time for nutrient absorption and ultimately leading to constipation. Diarrhea is not typically associated with the slowing of the gastrointestinal tract during pregnancy. Decreased absorption of iron and calcium may occur during pregnancy due to increased demands, but they are not directly related to the slowing of the gastrointestinal tract.
Which of the following treatments is not recommended for a child classified with no dehydration?
- A. Administering 1,000 ml to 1,400 ml within 4 hours
- B. Continuing feeding
- C. Allowing the child to take as much fluid as he wants
- D. Returning the child to the doctor if the condition worsens
Correct Answer: B
Rationale: The correct answer is B. Continuing feeding is a recommended treatment for a child classified with no dehydration. This helps maintain the child's nutritional status and supports recovery. Options A, C, and D are appropriate interventions for a child with no dehydration. Option A ensures adequate fluid intake, option C promotes hydration, and option D ensures appropriate follow-up if the condition worsens.
Which physiologic effect should the nurse expect in a client addicted to hallucinogens?
- A. Dilated pupils
- B. Constricted pupils
- C. Bradycardia
- D. Bradypnea
Correct Answer: B
Rationale: Clients addicted to hallucinogens often exhibit constricted pupils due to the effects of the drug on the sympathetic nervous system. This sympathetic stimulation causes the pupils to constrict rather than dilate. Choices A, C, and D are incorrect. Dilated pupils are more commonly associated with stimulant use, while bradycardia (slow heart rate) and bradypnea (slow breathing) are not typical effects of hallucinogens.
What is the first step in decontamination?
- A. Immediately applying a chemical decontamination foam to the area of contamination
- B. Thoroughly washing and rinsing the patient with soap and water
- C. Immediately applying personal protective equipment
- D. Removing the patient's clothing and jewelry, then rinsing the patient with water
Correct Answer: D
Rationale: The correct first step in decontamination is to remove the patient's clothing and jewelry to prevent further exposure and then rinse the patient with water. This helps to eliminate any contaminants on the patient's body. Choice A is incorrect because applying a chemical decontamination foam should come after removing clothing. Choice B is incorrect as washing and rinsing the patient should follow the removal of clothing. Choice C is incorrect as personal protective equipment should be worn by the individual performing the decontamination, not applied to the patient.
Knowing that for a comatose patient hearing is the last sense to be lost, as Judy¢â‚¬â„¢s nurse, what should you do?
- A. Tell her family that probably she can¢â‚¬â„¢t hear them
- B. Talk loudly so that Wendy can hear you
- C. Tell her family who are in the room not to talk
- D. Speak softly then hold her hands gently
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.