Nokea
Patients with a paralytic ileus typically have
- A. Intravenous fluid replacement and a nasogastric tube connected to suction.
- B. Surgical correction of the problem.
- C. Endoscopic injection of botulinum toxin or esophageal dilation.
- D. Endoscopy to allow biopsy followed with broad-spectrum antibiotics.
Correct Answer: A
Rationale: Paralytic ileus requires decompression of the gastrointestinal tract.
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During pulmonary hygiene for a client with pneumonia, a nurse positions the client on his left side in Trendelenburg position. From which of the following lung segments should the nurse expect secretions to be mobilized with the client in this position?
- A. Lateral segment of the left lower lobe
- B. Lateral segment of the right lower lobe
- C. Posterior segment of the right middle lobe
- D. Posterior segment of the right lower lobe
Correct Answer: B
Rationale: The correct answer is B: Lateral segment of the right lower lobe. In Trendelenburg position on the left side, gravity helps drain secretions from the right lung's lateral segments more effectively. The right lower lobe's lateral segment is the most dependent part of the lung in this position, facilitating secretion mobilization. Choices A, C, and D are incorrect because they do not align with the gravitational effect in Trendelenburg position on the left side, making secretion mobilization less efficient in those segments.
In planning Mrs. Filbert's care during an acute attack of Meniere disease, it would be most important to
- A. encourage her to discuss her feelings about her illness
- B. keep her siderails up and provide assistance when she is permitted out of bed
- C. instruct her about prescribed dietary modifications
- D. encourage her to walk around her room so that her joints will not get stiff
Correct Answer: C
Rationale: Dietary changes, such as reducing salt intake, play a key role in managing Meniere disease by helping control fluid balance in the inner ear.
A healthcare provider is preparing to admit a client to the PACU who received a competitive neuromuscular blocking agent. Which of the following items should the provider place at the client's bedside?
- A. Bag valve mask device
- B. Defibrillator machine
- C. Chest tube equipment
- D. Central venous catheter tray
Correct Answer: A
Rationale: The correct answer is A: Bag valve mask device. In the PACU, a client who received a competitive neuromuscular blocking agent may have impaired respiratory function. Placing a bag valve mask device at the bedside is crucial for providing immediate respiratory support if needed. This device allows manual ventilation in case of respiratory distress.
Summary:
- Choice B: Defibrillator machine is not necessary for a client receiving a competitive neuromuscular blocking agent.
- Choice C: Chest tube equipment is not typically needed for this situation.
- Choice D: Central venous catheter tray is not directly related to the respiratory support required for a client with impaired respiratory function.
End-of-life palliative nursing care involves
- A. Constant assessment for changes in physiologic functioning.
- B. Administering large doses of analgesics to keep the patient sedated.
- C. Providing as little physical care as possible to prevent disturbing the patient.
- D. Encouraging the patient and family members to verbalize their feelings of sadness
Correct Answer: D
Rationale: Emotional and psychological support for both the patient and family is crucial in palliative care, helping them process feelings and find closure.
Expected age-related changes of the pulmonary system include:
- A. Significant airway obstruction
- B. Shortness of breath
- C. Development of emphysema
- D. A modest,gradual decline in pulmonary function
Correct Answer: D
Rationale: While lung capacity decreases with age, it typically results in a gradual decline rather than significant obstruction or diseases like emphysema unless other factors (e.g., smoking) are present.