Nokea
The nurse is caring for a 9-year-old boy who presented to the ED after a penetrating injury from a BB gun. The client is diagnosed with a hyphema. The nurse proceeds to place the client in which position?
- A. flat in bed
- B. semi-Fowler's
- C. Trendelenburg's
- D. lateral on the unaffected side
Correct Answer: B
Rationale: Semi-Fowler's position (B) reduces intraocular pressure and prevents blood pooling in hyphema. Flat (A) or Trendelenburg's (C) may increase pressure, and lateral (D) is not standard.
You may also like to solve these questions
A client newly diagnosed with gout asks the nurse about the condition. Which statement should the nurse include in teaching for this client?
- A. Aspirin can be used for mild pain when you have a flare-up.
- B. Avoid foods high in purines such as organ meats and shellfish.
- C. Lasix can help keep your urine flushed out to lessen the chance of an attack.
- D. A few glasses of wine every week will help you reduce stress, which can trigger an attack.
Correct Answer: B
Rationale: Avoiding high-purine foods like organ meats and shellfish (B) reduces uric acid and gout flare-ups. Aspirin (A) may increase uric acid, Lasix (C) is not indicated, and alcohol (D) can trigger attacks.
The nurse is caring for a client experiencing an acute flare-up of diverticular disease. Which interventions by the nurse are appropriate for this client? Select all that apply.
- A. encourage a diet high in fiber
- B. insert a nasogastric (NG) tube
- C. administer enemas as ordered
- D. administer IV fluids as ordered
- E. encourage coughing and deep breathing
- F. check stools for frank or occult bleeding
Correct Answer: D,F
Rationale: IV fluids (D) and checking for bleeding (F) manage acute diverticulitis. High fiber (A) is for prevention, NG tube (B) and enemas (C) are contraindicated, and coughing/breathing (E) is unrelated.
The nurse is caring for a client who had a basilar artery stroke. The nurse would expect which signs and symptoms in this client?
- A. memory problems, visual hallucinations, visual deficits, hemisensory disturbances
- B. weakness in the foot and leg, sensory loss in the foot and leg, incontinence, ataxia, lack of spontaneity
- C. impaired consciousness, visual loss, bilateral sensory and motor dysfunction, and pupil abnormalities
- D. ataxia, contralateral facial weakness, contralateral hemiplegia, visual deficits, speech impairments, perceptual impairments
Correct Answer: C
Rationale: Basilar artery stroke affects the brainstem, causing impaired consciousness, visual loss, bilateral sensory/motor dysfunction, and pupil abnormalities (C). Other options (A, B, D) describe cortical or other stroke types.
What physical activity is recommended for a school-age child with asthma?
- A. distance running
- B. indoor swimming
- C. soccer
- D. basketball
Correct Answer: B
Rationale: Indoor swimming (B) is recommended for asthma due to warm, humid air reducing bronchospasm. Running (A), soccer (C), and basketball (D) may trigger symptoms.
The nurse is caring for a client who is on 2 L/minute of oxygen via nasal cannula. The nurse understands that this flow rate corresponds to which FiO2?
- A. 24% FiO2
- B. 28% FiO2
- C. 32% FiO2
- D. 36% FiO2
Correct Answer: B
Rationale: Nasal cannula at 2 L/min delivers ~28% FiO2 (B), calculated as 21% (room air) + 4% per liter.