Nokea
Which of the following Instructions should the nurse include?
- A. Remain on bed rest for 24 hours following the procedure.
- B. Participate in range-of-motion exercises.
- C. Use an incentive spirometer every 4 hours.
- D. Place a pillow under your knees while in bed.
Correct Answer: B
Rationale: The correct answer is B: Participate in range-of-motion exercises. This instruction is important to prevent complications such as blood clots and muscle stiffness post-procedure. Range-of-motion exercises help maintain joint flexibility and circulation. Choice A is incorrect as prolonged bed rest can increase the risk of blood clots. Choice C is important but not as crucial immediately post-procedure compared to mobilizing joints. Choice D is a comfort measure and does not have direct implications for post-procedure complications.
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Which of the following statements should the nurse include in the teaching?
- A. A nurse will draw blood from your baby's inner elbow.
- B. Your baby will be given 2 ounces of water to drink prior to the test.
- C. This test should be performed after your baby is 24 hours old.
- D. This test will be repeated when your baby is 2 months old.
Correct Answer: C
Rationale: Newborn genetic screening is most accurate when performed after the baby is 24 hours old.
A nurse is providing teaching to a client who has a new prescription for enoxaparin. Which of the following medications for pain relief should the nurse include in the teaching that can be taken concurrently with enoxaparin?
- A. Ibuprofen
- B. Naproxen sodium
- C. Acetaminophen
- D. Aspirin
Correct Answer: C
Rationale: Rationale: Acetaminophen is the appropriate pain relief option to be taken concurrently with enoxaparin because it does not interfere with platelet aggregation or clotting factors, unlike other options. Ibuprofen, naproxen sodium, and aspirin are nonsteroidal anti-inflammatory drugs (NSAIDs) which can increase the risk of bleeding when taken with enoxaparin. Acetaminophen, on the other hand, does not have the same effect on platelet function, making it a safer choice for pain relief in patients taking enoxaparin.
For each potential nursing action, click to specify if the action is indicated or not indicated for the client.
- A. Document the blood product transfusion in the client's medical record.
- B. Stay with the client for the first 15 min of the transfusion
- C. Titrate the rate of infusion to maintain the client's blood pressure at least 91/60 mm. Hg
- D. Obtain the first unit of packed RBCS from the blood bank.
- E. Start an IV bolus of lactated Ringers solution.
Correct Answer: A,B,D
Rationale: [A: 1, B: 1, C: 0, D: 1, E: 0, F: , G: ]
- A: Documenting blood product transfusion is crucial for legal and tracking purposes.
- B: Staying with the client ensures immediate response to any adverse reactions.
- C: Titration of infusion rate for BP is not within nursing scope without physician order.
- D: Obtaining packed RBCs precedes transfusion to verify compatibility.
- E: Starting IV bolus of LR is not indicated as it is unrelated to the transfusion process.
After notifying the provider, the nurse should-----and then-----
- A. prepare the client for cardiac catheterization
- B. request a prescription for an increase in statin medication
- C. administer oxygen at 2 L/min via nasal cannula
- D. request a prescription for a beta-blocker
- E. check a STAT cardiac troponin
- F. administer sublingual nitroglycerin
Correct Answer: C,F
Rationale: Oxygen and nitroglycerin are initial interventions for chest pain relief.
A nurse is creating a plan of care for a female client who has recurrent urinary tract infections. Which of the following interventions should the nurse include in the plan?
- A. Wear loose-fitting underwear.
- B. Take a bubble bath after intercourse.
- C. Drink four 240 mL(8 oz) glasses of water each day.
- D. Void every 5 to 6 hr during the day.
Correct Answer: A
Rationale: The correct answer is A: Wear loose-fitting underwear. Tight clothing can trap moisture and bacteria, leading to UTIs. Loose-fitting underwear allows for better air circulation, reducing the risk of infection. Choice B is incorrect as bubble baths can irritate the urinary tract. Choice C is important for hydration but not directly related to preventing UTIs. Choice D is good practice for bladder health but does not specifically address UTI prevention.