Nokea
Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.)
- A. Allow ambulation as tolerated.
- B. Monitor vital signs every 2 hours.
- C. Assess the affected extremity for temperature and color.
- D. Check pulses above the catheterization site for equality and symmetry.
Correct Answer: A
Rationale: Allowing ambulation as tolerated helps promote circulation and prevent complications such as blood clots.
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Parents have a concern that their child is depressed. The nurse relates that which characteristic best describes children with depression?
- A. Increased range of affective response
- B. Preoccupation with need to perform well in school
- C. Change in appetite, resulting in weight loss or gain
- D. Tendency to prefer play instead of schoolwork
Correct Answer: C
Rationale: Change in appetite, resulting in weight loss or gain, is a common characteristic seen in children with depression. Some children may experience a significant decrease in appetite, leading to weight loss, while others may have an increased appetite, resulting in weight gain. This change in eating habits is often a noticeable sign that may indicate the presence of depression in children. It is important for parents and caregivers to be aware of any significant changes in a child's eating patterns and behavior, as it could be a potential indicator of underlying mental health issues such as depression.
The nurse is assigned to care for a postoperative client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:
- A. Encourage the client to ask questions about personality sexuality
- B. Provide time for privacy
- C. Provide support for the spouse or significant other
- D. Suggest referral to a sex counselor or other appropriate professional
Correct Answer: D
Rationale: Suggesting a referral to a sex counselor or other appropriate professional would be the most appropriate intervention in this case. Impotence or erectile dysfunction can have significant emotional and psychological implications, especially in the context of a marital relationship. A sex counselor or therapist who specializes in sexual health can provide the necessary support, guidance, and strategies to help the client and his spouse navigate this issue effectively. This intervention is aimed at addressing the client's concerns about impotence, its impact on his marriage, and ultimately promoting holistic well-being.
Which of the following is an intraoperative outcome for a patient undergoing an inguinal hernia repair?
- A. Verbalizes fears
- B. Demonstrates leg exercises
- C. Maintains skin integrity
- D. Explains deep breathing exercises
Correct Answer: C
Rationale: Intraoperative outcomes refer to the immediate goals and conditions that are assessed during a surgical procedure. Maintaining skin integrity is a crucial intraoperative outcome for a patient undergoing an inguinal hernia repair surgery. This outcome focuses on ensuring that the patient's skin remains intact, without any damage or breakdown during the surgical procedure. It involves proper positioning of the patient, adequate support to vulnerable areas, and meticulous monitoring of the skin throughout the surgery to prevent any pressure injuries or skin trauma. Other outcomes listed, such as verbalizing fears, demonstrating leg exercises, and explaining breathing exercises, are more pertinent to preoperative or postoperative care rather than intraoperative outcomes.
The nurse needs to administer an IM injection of 2.4 million units of penicillin G. it is supplied in a vial of 5,000,000 units of powder for injection. Instructions state to dilute with 8 mL of sterile water. How manu mL should the nurse draw up?
- A. 2.6 mL
- B. 4.1 mL
- C. 3.8 mL
- D. 4.4 mL
Correct Answer: B
Rationale: To administer an IM injection of 2.4 million units of penicillin G, the nurse should first reconstitute the penicillin powder with sterile water as per the instructions. The vial contains 5,000,000 units of the powder and when diluted with 8 mL of sterile water, the resulting concentration would be:
Use of condoms of those found to be infected with HIV
- A. 1 & 3
- B. 3 & 4
- C. 2 & 3 SITUATION; Mr. Baldo , 36 years old patient complaints of fatigue, weight loss, and low-grade fever. He also has pa in his fingers, elbows, and ankles.
Correct Answer: B
Rationale: In the given scenario involving Mr. Baldo presenting with symptoms of fatigue, weight loss, low-grade fever, and joint pain in fingers, elbows, and ankles, it is suggested that he may potentially have rheumatoid arthritis. Therefore, options 3 and 4 are the correct choices. Option 3 mentions the administration of NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) for pain management, which is a common treatment approach for rheumatoid arthritis to help reduce inflammation and manage pain. Option 4 suggests consulting a rheumatologist for further evaluation and management, which is crucial in determining the appropriate diagnosis and treatment plan for Mr. Baldo's condition.