Nokea
The client who has been hospitalized with pancreatitis does not drink alcohol because of her religious convictions. She becomes upset when the physician persists in asking her about alcohol intake. The nurse should explain that the reason for these questions is that:
- A. There is a strong link between alcohol use and acute pancreatitis.
- B. Alcohol intake can interfere with the tests used to diagnose pancreatitis.
- C. Alcoholism is a major health problem, and all clients are questioned about alcohol intake.
- D. The physician must obtain the pertinent facts, regardless of religious beliefs.
Correct Answer: A
Rationale: Alcohol is a primary cause of acute pancreatitis, so questioning its use (A) is essential to identify etiology. Interference with tests (B), general alcoholism screening (C), or disregarding beliefs (D) are not accurate explanations.
You may also like to solve these questions
The nurse is instructing a client who is at risk for peripheral vascular disease how to use knee-length elastic stockings (support hose). The teaching plan should include which of the following? Check all that apply.
- A. Apply the elastic stockings in the morning
- B. Remove the stockings if swelling occurs
- C. Apply the stockings while in bed
- D. Once the stockings have been pulled over the calf, roll the remaining stocking down to make a cuff
- E. Keep the stockings in place for 48 hours and reapply using a clean pair of stockings
Correct Answer: A,C
Rationale: Rationales: A) Applying elastic stockings in the morning before edema worsens helps promote venous return. C) Applying them while in bed (before standing) minimizes swelling and eases application. B) Removing stockings for swelling requires medical evaluation, not automatic removal. D) Rolling down to form a cuff creates pressure points, impairing circulation. E) Stockings should be removed daily for skin inspection and hygiene, not kept on for 48 hours.
The nurse is preparing to hang a new TPN bag. Which step is essential to prevent infection?
- A. Use clean gloves during setup.
- B. Verify the solution with another nurse.
- C. Change the tubing every 48 hours.
- D. Administer through a peripheral line.
Correct Answer: B
Rationale: Verifying the TPN solution with another nurse ensures accuracy and prevents errors that could lead to infection or other complications. Clean gloves are insufficient (sterile technique is needed), tubing change frequency varies, and TPN is typically given via a central line. CN: Safety and infection control; CL: Synthesize
The nurse is developing a plan of care for the client with viral hepatitis. The nurse should instruct the client to:
- A. Obtain adequate bed rest.
- B. Increase fluid intake.
- C. Follow a high-protein diet.
- D. Avoid carbohydrates.
Correct Answer: A
Rationale: Adequate bed rest (A) supports recovery in viral hepatitis by reducing metabolic demands. Increased fluids (B) are helpful but secondary. High-protein (C) or avoiding carbohydrates (D) is not indicated.
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?
- A. Take one tablet every 2 to 5 minutes until the pain stops.
- B. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes.
- C. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets.
- D. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.
Correct Answer: C
Rationale: Standard protocol for sublingual nitroglycerin is one tablet every 5 minutes for up to three doses. If pain persists, the client should seek medical help.
On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client the nurse should do which of the following?
- A. Encourage the client to apply full weightbearing.
- B. Order a walker for the client.
- C. Place a straight-backed chair at the foot of the bed.
- D. Apply a knee immobilizer.
Correct Answer: D
Rationale: A knee immobilizer ensures stability and safety during initial transfers post-surgery.