Nokea
The leukemic client is prescribed a low-bacteria diet. Which does the nurse expect to be included in this diet?
- A. Cooked spinach and sautéed celery
- B. Lettuce and alfalfa sprouts
- C. Fresh strawberries and whipped cream
- D. Raw cauliflower or broccoli
Correct Answer: A
Rationale: A low-bacteria diet includes cooked vegetables like spinach and celery to minimize infection risk, unlike raw foods (lettuce, strawberries, cauliflower) that may harbor bacteria.
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The nurse has an order to administer 100 units of regular insulin in 500 mL of 0.9% NS to infuse at 12 units per hour. The nurse should program the IV pump to deliver how many mLs per hour?
Correct Answer: 60
Rationale: Concentration: 100 units/500 mL = 0.2 units/mL. To deliver 12 units/hour: 12 ÷ 0.2 = 60 mL/hour.
The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirm a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
- A. Prostigmine (neostigmine)
- B. Atropine (atropine sulfate)
- C. Didronel (etidronate)
- D. Tensilon (edrophonium)
Correct Answer: A
Rationale: Neostigmine (Prostigmine) is a cholinesterase inhibitor used to improve muscle strength in myasthenia gravis.
A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?
- A. Insulin requirements moderate as the pregnancy progresses.
- B. A decreased need for insulin occurs during the second trimester.
- C. Elevations in human chorionic gonadotrophin decrease the need for insulin.
- D. Fetal development depends on adequate insulin regulation.
Correct Answer: D
Rationale: Adequate insulin regulation is critical for fetal development in diabetic pregnancies.
The client with a myocardial infarction comes to the nurse's station stating that he is ready to go home because there is nothing wrong with him. Which defense mechanism is the client using?
- A. Rationalization
- B. Denial
- C. Projection
- D. Conversion reaction
Correct Answer: B
Rationale: Denial involves refusing to acknowledge a serious condition.
A client is admitted with suspected pernicious anemia. Which findings support the diagnosis of pernicious anemia?
- A. The client complains of feeling tired and listless.
- B. The client has waxy, pale skin.
- C. The client exhibits loss of coordination and position sense.
- D. The client has a rapid pulse rate and a detectable heart murmur.
Correct Answer: C
Rationale: Loss of coordination and position sense are neurological symptoms due to vitamin B12 deficiency in pernicious anemia.