For which of the ff conditions would the use of salt tablets be considered?
- A. a. Mild deficits of serum sodium
- B. Severe deficits of serum magnesium
- C. Severe deficits of serum potassium
- D. Severe deficits of serum calcium
Correct Answer: A
Rationale: Rationale:
- Salt tablets are used for mild deficits of serum sodium to help restore electrolyte balance.
- Sodium is crucial for fluid balance, nerve function, and muscle contraction.
- Severe deficits of serum magnesium, potassium, and calcium require specific electrolyte replacement therapy, not salt tablets.
Summary:
- Choice A is correct because salt tablets are used for mild deficits of serum sodium.
- Choices B, C, and D are incorrect because they involve severe deficits of different electrolytes that require specific replacement therapy.
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A 39-year old male client underwent Transurethral Resection of the Prostate (TURP) eight hours ago and asks the nurse, “Why is my urine in the bag clotting like blood?” The nurse’s best interpretation of this finding is that:
- A. after the surgery, bleeding is normal
- B. it is common for blood clots to be irrigated from the bladder for a day or so
- C. the physician needs to be called as the patient is bleeding
- D. the client is tugging on the catheter causing irritation to the bladder mucosa
Correct Answer: A
Rationale: The correct answer is A: after the surgery, bleeding is normal. This is because after a TURP procedure, it is common for some bleeding to occur, leading to blood clots in the urine bag. The surgical site undergoes trauma, causing bleeding as a part of the healing process.
Choice B is incorrect because while irrigation may be done post-surgery, blood clots in the urine bag are expected due to the surgery itself, not just irrigation. Choice C is incorrect as it is normal for some bleeding to occur after TURP, and immediate physician intervention is not necessary unless excessive bleeding is observed. Choice D is incorrect as tugging on the catheter may cause bleeding, but in this case, the presence of blood clots is likely due to the surgery itself, not catheter irritation.
A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding?
- A. It’s normal and requires no action
- B. It calls for a repeat Pap test in 6 weeks
- C. It calls for a repeat Pap test in 3 months
- D. It calls for a biopsy as soon as possible
Correct Answer: D
Rationale: The correct answer is D because a class V Pap test finding indicates severe abnormalities, such as high-grade dysplasia or carcinoma in situ. Therefore, the nurse should instruct the client to undergo a biopsy as soon as possible to confirm the diagnosis and initiate appropriate treatment promptly. Choices A, B, and C are incorrect because a class V result is not normal and requires immediate follow-up, rather than waiting or repeating the Pap test at a later time.
A client is admitted to the ICU, which laboratory result must be reported immediately to the physician?
- A. Hematocrit 48%
- B. paCO2 38 mm Hg
- C. platelets 18,000
- D. WBC count 8000
Correct Answer: C
Rationale: The correct answer is C: platelets 18,000. A critically low platelet count can lead to life-threatening bleeding in the ICU. Normal platelet count ranges from 150,000 to 450,000. A count of 18,000 indicates severe thrombocytopenia. Immediate reporting is crucial for prompt intervention.
Rationale for why other choices are incorrect:
A: Hematocrit of 48% is within normal range (male: 42-52%, female: 37-47%).
B: paCO2 of 38 mm Hg is within normal range (35-45 mm Hg).
D: WBC count of 8000 is within normal range (4000-11000/uL).
In critical care settings, it is vital to prioritize and address life-threatening conditions promptly, hence the urgent need to report the critically low platelet count.
An adult is to receive an IM injection of Morphine for post op pain. Which of the following is necessary for the nurse to assess prior to giving a narcotic analgesic?
- A. The client’s level of alertness and respiratory rate
- B. The last time the client ate or drank something
- C. The client’s bowel habits and last bowel movement
- D. The client’s history of addictions
Correct Answer: A
Rationale: The correct answer is A. Before administering a narcotic analgesic like Morphine, assessing the client's level of alertness and respiratory rate is crucial to ensure they can tolerate the medication without compromising their breathing. Alertness indicates their ability to handle potential side effects, while respiratory rate is vital to monitor for any signs of respiratory depression.
Choice B (last meal) is not directly related to giving a narcotic analgesic, although it may impact the absorption rate. Choice C (bowel habits) and last bowel movement are not immediately relevant to assessing the client's readiness for a narcotic analgesic. Choice D (history of addictions) is important but not the priority when assessing for immediate safety and efficacy of the medication.
The nurse is reviewing the medication history of a new preoperative patient who is nil by mouth (NPO). The nurse notes that the patient has been on long-term oral steroid therapy. The nurse understands that which of the following is the reason that steroids cannot be abruptly stopped?
- A. Higher steroid levels are needed during
- B. Malignant hypertension will occur.
- C. Respiratory failure will result.
- D. Malignant hyperthermia will result.
Correct Answer: A
Rationale: The correct answer is A because abruptly stopping steroids can lead to adrenal insufficiency due to suppression of the adrenal glands. This can result in a sudden drop in cortisol levels, which are essential for various physiological functions. Patients on long-term steroid therapy need a gradual taper to allow the adrenal glands to resume cortisol production. Choices B, C, and D are incorrect as they do not directly relate to the physiological effects of stopping steroids abruptly.