Nokea
Give an example of a sensitive way to ask a patient each of the following questions.
- A. Is the patient on antihypertensive medication having a side effect of impotence?
- B. Has the patient with a history of alcoholism had recent alcohol intake?
- C. Who are the sexual contacts of a patient with gonorrhea?
- D. Does the patient skip taking medications because they cost too much?
Correct Answer: B
Rationale: N/A
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The first priority to care for the patient with a new fracture includes assessing
- A. Respiratory rate and effort, as well as pulse.
- B. The fracture site for bleeding.
- C. For signs of infection at the wound site of an open fracture.
- D. For circulation and sensation distal to the fracture site.
Correct Answer: D
Rationale: Assessing circulation and sensation ensures no compromise to distal structures.
Priority Decision: A patient in the PACU has emergence delirium manifested by agitation and thrashing. What should the nurse assess for first in the patient?
- A. Hypoxemia
- B. Neurologic injury
- C. Distended bladder
- D. Cardiac dysrhythmias
Correct Answer: A
Rationale: Hypoxemia is a common cause of agitation and delirium during emergence from anesthesia.
6. What is the rationale behind many nurses advocating complementary and alternative therapies?
- A. They promote self-care and self-determination by patients.
- B. They are congruent with a view of humans as holistic beings.
- C. They are less expensive for patients than conventional therapies.
- D. They cause few adverse effects while achieving positive outcomes.
Correct Answer: B
Rationale: Many nurses advocate CAM because it aligns with a holistic view of health, considering physical, emotional, and spiritual aspects, as stated in option B.
Appropriate treatment for a patient with cellulitis includes
- A. Petrolatum and vitamin A and D ointment.
- B. Antibiotics, such as cephalexin, and over-the-counter analgesics.
- C. Weight-bearing exercises and diuretics, such as furosemide.
- D. Wet to dry dressings and steroids.
Correct Answer: B
Rationale: Antibiotics are the mainstay of treatment for cellulitis.
A client is unconscious with a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?
- A. Kussmaul respirations
- B. Apneustic respirations
- C. Cheyne-Stokes respirations
- D. Stridor
Correct Answer: C
Rationale: The correct answer is C: Cheyne-Stokes respirations. This breathing pattern is characterized by alternating periods of deep, rapid breathing (hyperventilation) followed by periods of apnea. This pattern is often seen in clients with neurological or cardiac conditions. Kussmaul respirations (A) are deep and rapid breathing associated with metabolic acidosis. Apneustic respirations (B) are characterized by prolonged inhalation and short, insufficient exhalation. Stridor (D) is a high-pitched, noisy breathing sound caused by obstructed air flow in the upper airway, not associated with the described breathing pattern.