Nokea
The client is admitted with hypokalemia. An IV of normal saline is infusing at $80 \mathrm{ml} /$ hour with 10 meq of $\mathrm{KCl} /$ hour. Prior to beginning the infusion, the nurse should:
- A. Check the sodium level.
- B. Check the magnesium level.
- C. Check the creatinine level.
- D. Check the calcium level.
Correct Answer: B
Rationale: Hypokalemia is often associated with hypomagnesemia, which can impair potassium correction. Checking the magnesium level ensures effective treatment. Sodium , creatinine , and calcium levels are less directly related to potassium infusion safety.
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An 18-month old has been hospitalized six times for upper airway infections. Diagnostic studies including sweat analysis confirm the diagnosis of cystic fibrosis. Which of the following statements describes the inheritance pattern for cystic fibrosis?
- A. An affected gene is inherited from both the father and mother, who remain symptom free.
- B. Males are at risk at twice the rate as females.
- C. Autosomal recessive disorders tend to skip generations, so the children of affected parents will have children with the disorder.
- D. The disorder is transmitted by an affected gene on one of the six chromosomes.
Correct Answer: A
Rationale: Cystic fibrosis is an autosomal recessive disorder, requiring a mutated gene from both parents, who are carriers but asymptomatic.
The mother of 6-month-old twins is in the doctor's office because one of the infants has an ear infection. The mother says to the nurse, 'I just don't know if I can handle another problem. It is all so overwhelming.' How should the nurse respond initially?
- A. You're their mother. I'm sure you know what's best for them.'
- B. Have you called social services to see if you qualify for assistance?'
- C. My sister had twins and she survived. You will too.'
- D. It must be tough to have two little ones. What seems to be the biggest problem?'
Correct Answer: D
Rationale: Acknowledging the mother's stress and exploring her challenges builds rapport and identifies support needs. Other responses dismiss or redirect her concerns.
A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What would be the initial action by the nurse?
- A. Arrange to change client care assignments
- B. Explain that this behavior is expected
- C. Discuss the appropriate use of time-out
- D. Explain that the child needs extra attention
Correct Answer: B
Rationale: Explain that this behavior is expected. Fear of strangers is normal in toddlers and extends into the preschool period.
The physician has recommended that an adult male be scheduled for a left heart catheterization. The client asks the nurse what a cardiac catheterization is for. What information should be included when responding to this client?
- A. During a left heart catheterization, the coronary arteries can be visualized.
- B. During a left heart catheterization, holes in the heart walls can be detected.
- C. During a left heart catheterization, blood flow to the lungs can be measured.
- D. During a left heart catheterization, oxygen levels in the chambers of the heart are measured.
Correct Answer: A
Rationale: Left heart catheterization visualizes coronary arteries to assess for blockages, aiding in diagnosing coronary artery disease.
A woman is scheduled for an electromyography procedure (EMG) in the outpatient department. What should the nurse say to the woman?
- A. Do not eat or drink anything after midnight the night before the procedure.'
- B. Are you allergic to shellfish or iodine?'
- C. Do not eat or drink anything that contains caffeine for two to three days before the procedure.'
- D. There is no special preparation for this procedure.'
Correct Answer: D
Rationale: EMG requires no special preparation, as it involves muscle and nerve testing without fasting, allergies, or caffeine restrictions.