Nokea
An older adult with heart failure is hospitalized during an acute exacerbation. To reduce cardiac workload, which intervention should the nurse include in the client's plan of care?
- A. Assist with ambulation in the hallway
- B. Encourage active range of motion exercises
- C. Provide a bedside commode for toileting
- D. Teach to sleep in a side-laying position
Correct Answer: C
Rationale: Providing a bedside commode reduces the need for the client to walk to the bathroom, decreasing strain on the heart.
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Common causes of seizures in a neonate are:
- A. Hypocalcaemia
- B. Hypoglycaemia
- C. Pyridoxine deficiency
- D. Hydrocephalus
Correct Answer: B
Rationale: The correct answer is B because hypoglycaemia is a common cause of neonatal seizures. The other options (a, c, d, e) are also causes but less common.
The typical radiologic configuration in tetralogy of Fallot as seen in the anteroposterior view consists of all the following EXCEPT
- A. normal heart size
- B. some elevation of the cardiac apex
- C. convexity in the region of the main pulmonary artery
- D. right-sided aortic arch
Correct Answer: A
Rationale: Normal heart size is not typical in tetralogy of Fallot.
Regarding a supracristal VSD, the following are true EXCEPT
- A. incidence is higher in Asian children
- B. complicated by aortic insufficiency in 50-90% of patients
- C. aortic insufficiency is most often not recognized until late in the lst decade of life
- D. murmur of a supracristal VSD is usually heard at the mid to upper left sternal border
Correct Answer: D
Rationale: Closure of asymptomatic supracristal VSDs at the time of diagnosis is not recommended.
The following cranial nerves carry pre-ganglionic parasympathetic nerves:
- A. Oculomotor nerve
- B. Trigeminal nerve
- C. Facial nerve
- D. Vagus nerve
Correct Answer: D
Rationale: The vagus nerve carries parasympathetic fibers. The oculomotor, trigeminal, and facial nerves do not.
A client with a productive cough has obtained a sputum specimen for culture as instructed. What is the best initial nursing action?
- A. Administer the first dose of antibiotic therapy
- B. Observe the color, consistency, and amount of sputum
- C. Encourage the client to consume plenty of warm liquids
- D. Send the specimen to the lab for analysis
Correct Answer: B
Rationale: Observing the color, consistency, and amount of sputum helps in assessing the nature of the infection and guides further treatment. Sending the specimen to the lab is important but not the first action.