Nokea
The nurse is caring for a client who is experiencing an acute exacerbation of asthma. Which of the following medications should the nurse administer to the client? Select all that apply.
- A. albuterol
- B. buproten
- C. ipratropium
- D. tobramycin
- E. montelukast
Correct Answer: A, C
Rationale: Albuterol (A) and ipratropium (C) are bronchodilators used in acute asthma exacerbations. Ibuprofen (B), tobramycin (D), and montelukast (E) are not indicated for acute management.
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The nurse working on a pediatric oncology unit recognizes which as a personal coping strategy for remaining effective when caring for dying children?
- A. Attending a child's memorial service
- B. Avoiding expressing personal feelings of grief or loss directly with the family
- C. Ending personal contact with the deceased's family members after they leave the hospital
- D. Increasing length of daily exercise routines
Correct Answer: D
Rationale: Increasing exercise (D) is a healthy coping strategy to manage stress. Attending memorials (A), avoiding grief expression (B), or ending contact (C) may not promote long-term emotional resilience.
A 45-year-old client is in a rehabilitation unit receiving long-term care for injuries sustained in a motor vehicle accident. The client's spouse used to stay home but started working to replace the client's lost income. The nurse notices that the client has become withdrawn and increasingly frustrated by small inconveniences. Which statement is the most appropriate first response by the nurse?
- A. How is your spouse's new job going?'
- B. I've noticed that you seem frustrated lately.'
- C. It's normal to be angry when you can't work anymore.'
- D. We have a support group that can help you adjust to rehab.'
Correct Answer: B
Rationale: Acknowledging observed behavior (B) opens a therapeutic conversation and validates the client's feelings. Asking about the spouse's job (A), assuming anger (C), or suggesting a support group (D) may not address the client's current emotional state.
The nurse is collecting data from a 10-year-old client during a routine physical examination. Which of the following actions should the nurse take? Select all that apply.
- A. Use correct anatomical terminology while reinforcing teaching about self-care.
- B. Conduct a head-to-toe examination in the same sequence as an adult examination.
- C. Explain the purpose of the examination equipment and any procedures to the client.
- D. Offer the client a gown and allow the client to keep the underwear on during the examination.
- E. Ask the accompanying parent to rate and describe any pain the client may be experiencing.
Correct Answer: A, C, D
Rationale: Using anatomical terminology (A) promotes understanding. Explaining equipment and procedures (C) reduces anxiety. Offering a gown and allowing underwear (D) respects privacy. Adult examination sequences (B) may not suit pediatric needs, and parents rating pain (E) may not accurately reflect the child's experience.
Following an arteriogram, the nurse should give priority to:
- A. Allowing the client to rest
- B. Administering O2 via nasal mask
- C. Checking the ECG monitor
- D. Checking the pulses distal to the catheterization site
Correct Answer: D
Rationale: Checking distal pulses ensures adequate circulation post-arteriogram, as the procedure involves arterial puncture, which can lead to complications like hematoma or thrombosis.
The nurse is assisting the physician with an examination of a client with Addison's disease. During the examination, the nurse will note which change in the client's integumentary system?
- A. Edema of the hands and feet
- B. Hirsutism
- C. Bronze pigmentation
- D. Pendulous abdomen
Correct Answer: C
Rationale: Addison's disease causes bronze pigmentation due to increased ACTH. Edema , hirsutism , and pendulous abdomen are not typical.