Nokea
The nurse is preparing a client for a paracentesis. The nurse should:
- A. Have the client void immediately before the procedure.
- B. Place the client in a side-lying position.
- C. Initiate an I.V. line to administer sedatives.
- D. Place the client on nothing-by-mouth (NPO) status 6 hours before the procedure.
Correct Answer: A
Rationale: Voiding before paracentesis (A) prevents bladder injury during the procedure. Side-lying (B) is incorrect; upright is preferred. IV sedatives (C) are not routine, and NPO status (D) is unnecessary.
You may also like to solve these questions
What should the nurse assess first in a client with a recent head injury?
- A. Pupil response.
- B. Blood pressure.
- C. Pain level.
- D. Reflexes.
Correct Answer: A
Rationale: Pupil response is assessed first to detect neurological changes, such as increased intracranial pressure, in a head injury.
A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up appointment. The nurse notes several small bandages covering cuts on the client's hands. The client says, 'I'm so clumsy. I'm always cutting my finger cooking or burning myself on the iron.' Which of the following responses by the nurse would be most appropriate?
- A. Soak small wounds in isopropyl alcohol.'
- B. Keep all cuts clean and covered.'
- C. Why don't you have your children do the cooking and ironing?'
- D. You really should be fine as long as you take your daily medication.'
Correct Answer: B
Rationale: Keeping cuts clean and covered prevents infection, a significant risk in diabetes due to poor wound healing.
Upon assessment of third degree heart block on the monitor, the nurse should first:
- A. Call a code.
- B. Begin cardiopulmonary resuscitation.
- C. Have transcutaneous pacing ready at the bedside.
- D. Prepare for defibrillation.
Correct Answer: C
Rationale: Third-degree heart block may require pacing. Having transcutaneous pacing ready is the first step to manage symptomatic bradycardia.
What is the rationale that supports multidrug treatment for clients with tuberculosis?
- A. Multiple drugs potentiate the drugs' actions.
- B. Multiple drugs reduce undesirable drug adverse effects.
- C. Multiple drugs allow reduced drug dosages to be given.
- D. Multiple drugs reduce development of resistant strains of the bacteria.
Correct Answer: D
Rationale: Multidrug therapy for tuberculosis prevents the development of resistant bacterial strains by targeting different aspects of bacterial growth. Potentiation, reduced adverse effects, or lower dosages are not the primary rationale.
The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids?
- A. Take your medication with a full glass of water.'
- B. Take your medication on an empty stomach.'
- C. Take your medication at bedtime to increase absorption.'
- D. Take your medication with meals or with an antacid.'
Correct Answer: D
Rationale: Taking glucocorticoids with meals or an antacid reduces gastrointestinal irritation, a common side effect.