Nokea
An adult has and IV line in the right forearm infusing D5 ½ NS with 20 mEq of potassium at 75 ml/h. which statement would be a correct report from the RN?
- A. The potassium bag is piggybacked into the dextrose at 75ml/h
- B. The clamp should be closed below the D5 ½ NS bag
- C. Potassium is on the secondary line
- D. 75 ml infuse in one hour
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. Potassium is typically administered on a secondary line to prevent rapid infusion and potential adverse effects.
2. The primary line carries the D5 ½ NS solution without potassium, while the secondary line delivers the potassium.
3. Reporting that "potassium is on the secondary line" accurately describes the setup for this IV infusion.
Summary:
A: Incorrect - Incorrectly states that the potassium bag is piggybacked into the dextrose.
B: Incorrect - Closing the clamp below the D5 ½ NS bag is unnecessary and does not address the potassium infusion.
D: Incorrect - Fails to address the specific issue of the potassium infusion being on a secondary line.
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- A. I.M. or subcutaneous glucagon.
- B. I.V. bolus of dextrose 50%.
- C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
- D. 10 U of fast-acting insulin.
Correct Answer: C
Rationale: The correct answer is C: 15 to 20 g of a fast-acting carbohydrate such as orange juice. In this scenario, the client is experiencing hypoglycemia, which can lead to confusion and abnormal behavior. Administering fast-acting carbohydrates like orange juice will help quickly raise the blood sugar levels. This is the first-line treatment for conscious patients with hypoglycemia.
Choice A (I.M. or subcutaneous glucagon) is used for unconscious patients or when oral intake is not possible. Choice B (I.V. bolus of dextrose 50%) is too aggressive for a conscious patient and may lead to complications. Choice D (10 U of fast-acting insulin) would further lower the blood sugar levels and worsen the situation.
Administering fast-acting carbohydrates is the safest and most effective approach for conscious patients with hypoglycemia to quickly raise their blood sugar levels and resolve their symptoms.
After surgery the nurse notes that the patient’s urine is dark amber and concentrated. Which of the following does the nurse understand may be the reason for this?
- A. The sympathetic nervous system saves fluid in response to stress of surgery.
- B. The sympathetic nervous system diereses fluid in response to stress of surgery.
- C. The parasympathetic nervous system saves fluid in response to stress of surgery.
- D. The parasympathetic nervous system diereses fluid in response to stress of surgery.
Correct Answer: A
Rationale: The correct answer is A: The sympathetic nervous system saves fluid in response to the stress of surgery. The sympathetic nervous system is responsible for the "fight or flight" response, which includes the conservation of fluids during stressful situations. Dark amber and concentrated urine indicates dehydration, which can be a result of the sympathetic nervous system conserving fluids.
B: The sympathetic nervous system does not "diereses" (increase urination) in response to stress.
C: The parasympathetic nervous system is not involved in fluid conservation during stress.
D: The parasympathetic nervous system does not "diereses" fluid in response to stress.
Which of the following signs indicates to the nurse that digoxin (Lanoxin) has been effective for a patient?
- A. Urine output decreases
- B. Heart rate higher than 95
- C. Urine output increases
- D. Heart rate lower than 50
Correct Answer: C
Rationale: The correct answer is C: Urine output increases. This indicates digoxin's effectiveness as it improves cardiac output by enhancing contraction strength. Increased urine output signifies improved kidney perfusion due to enhanced cardiac function. Option A is incorrect as decreased urine output indicates poor kidney perfusion. Option B is incorrect as digoxin aims to regulate heart rate, not necessarily make it higher than 95. Option D is incorrect as a heart rate lower than 50 could indicate digoxin toxicity.
A form of cancer therapy wherein a beam of high-energy electromagnetic radiation desires the cancer ceils?
- A. surgery
- B. radiation therapy
- C. chemotherapy
- D. pallitive treatment Situation: The nurse is assigned in a counseling clinic about preventive measures for cancers.
Correct Answer: B
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- A. Reviewing the current literature to determine evidence-based nursing actions
- B. Checking orders for diagnostic and laboratory tests
- C. Performing a physical examination
- D. Ordering medications
Correct Answer: C
Rationale: The correct answer is C: Performing a physical examination. This method allows the nurse to gather objective data directly from the patient's body, such as vital signs, skin condition, and overall health status. It provides a comprehensive overview of the patient's current health status and helps in establishing a baseline for further assessments and interventions.
Reviewing literature (A) is important for evidence-based practice but does not directly establish a patient's database. Checking orders for tests (B) is essential but does not provide a holistic view of the patient. Ordering medications (D) is a treatment intervention and not a data collection method.