Nokea
The nurse is monitoring a client who just finished a meal for vasomotor manifestations of dumping syndrome. Which of the following findings indicate this occurrence?
- A. Dizziness and pallor
- B. Abdominal cramping and pain
- C. Bradycardia and indigestion
- D. Double vision and chest pain
Correct Answer: A
Rationale: Vasomotor symptoms (dizziness, pallor, diaphoresis) occur from rapid fluid shifts in dumping syndrome.
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A client arrives at the emergency room with symptoms of peptic ulcer disease. Which of these symptoms should the nurse identify as the priority?
- A. Hematemesis
- B. Abdominal bloating
- C. Epigastric discomfort
- D. Dyspepsia
Correct Answer: A
Rationale: Hematemesis indicates active bleeding and is the most urgent concern.
A client is admitted to the emergency department after sustaining multiple rib fractures in a motor vehicle accident. Upon assessment, the nurse notes that the client has flail chest. Which of the following signs and symptoms are associated with this condition? (Select all that apply.)
- A. Bradycardia
- B. Anxiety
- C. Dyspnea
- D. Unequal chest expansion
- E. Hypotension
- F. Paradoxical chest movement
Correct Answer: B,C,D,E,F
Rationale: Flail chest causes respiratory distress, paradoxical movement, and can lead to shock.
The healthcare provider has determined that a client has contracted hepatitis A based on flu-like symptoms and jaundice. Which statement made by the client supports this medical diagnosis?
- A. I was an intravenous drug abuser in the past and shared needles.
- B. I ate shellfish about 2 weeks ago at a local restaurant.
- C. I had a blood transfusion 30 years ago after major abdominal surgery.
- D. I have had unprotected sex with multiple partners.
Correct Answer: B
Rationale: Hepatitis A is typically transmitted through contaminated food/water - shellfish is a known source.
A nurse is teaching a client about self-administering peritoneal dialysis. Which of the following statements by the client indicates a need for further teaching?
- A. The microwave in my kitchen can warm the solution before I use it.
- B. The catheter can become infected even with sterile precautions.
- C. The volume of the output solution should be greater than the input solution.
- D. The fluid from my abdomen will be clear or slightly yellow.
Correct Answer: A
Rationale: Microwaving can unevenly heat solution and is not recommended; solutions should be warmed using approved methods.
A nurse is reviewing the arterial blood gas (ABG) values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
- A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
- B. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
- C. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg
- D. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
Correct Answer: A
Rationale: The values indicate metabolic acidosis with compensatory respiratory alkalosis, typical in CKD due to impaired acid excretion.