Nokea
The physician of an alcoholic client places him on a low-protein, high-carbohydrate diet. When choosing his menu, the client's best choice from the items below would be:
- A. Liver and onions, macaroni and cheese, tea with sugar
- B. Baked chicken, baked potato with bacon bits, milk
- C. Waffles with butter and honey, orange juice
- D. Cheese omelette with ham and mushrooms, milk
Correct Answer: C
Rationale: Serum ammonia levels can be decreased by restricting dietary protein intake. Waffles, honey, and orange juice are high in carbohydrate and low or completely lacking in protein. Butter, a concentrated fat, will provide extra calories.
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The nurse is caring for a client with a spinal cord injury at C5. Which complication is the client at greatest risk for?
- A. Respiratory depression
- B. Autonomic dysreflexia
- C. Pressure ulcers
- D. Deep vein thrombosis
Correct Answer: A
Rationale: A C5 spinal cord injury impairs diaphragm function (innervated by C3–C5), placing the client at greatest risk for respiratory depression due to weak respiratory muscles. The other complications are risks but less immediate.
The nurse is caring for a newborn with a suspected diaphragmatic hernia. The nurse should:
- A. Place the infant in Trendelenburg position
- B. Begin intravenous fluids immediately
- C. Maintain a quiet environment
- D. Position the infant on the affected side
Correct Answer: D
Rationale: Positioning a newborn with a diaphragmatic hernia on the affected side facilitates lung expansion on the unaffected side, improving respiration. Trendelenburg worsens breathing, and fluids are secondary.
A child is admitted with suspected epiglottitis. Which action is not a part of the nursing care?
- A. Checking the vital signs
- B. Assessing the throat with a tongue blade
- C. Administering oxygen as needed
- D. Administering IV antibiotics
Correct Answer: B
Rationale: Assessing the throat with a tongue blade is contraindicated in suspected epiglottitis as it may trigger airway obstruction. Vital signs oxygen and antibiotics are appropriate interventions.
The nurse is performing discharge teaching on a client at high risk for the development of skin cancer. Which instruction should be included in the client teaching?
- A. "You should see the doctor every six months."
- B. "Sunbathing should be done between the hours of noon and 3 p.m."
- C. "If you have a mole, it should be removed and biopsied."
- D. "You should wear sunscreen when going outside."
Correct Answer: D
Rationale: Wearing sunscreen protects against UV radiation, a key skin cancer risk factor. Regular checkups (A) are less specific, sunbathing at peak hours (B) increases risk, and routine mole removal (C) is excessive.
A 23-year-old male client is admitted to the chemical dependency unit with a medical diagnosis of alcoholism. He reports that the last time he drank was 3 days ago, and that now he is starting to 'feel kind of shaky.' Based on the information given above, nursing care goals for this client will initially focus on:
- A. Self-concept problems
- B. Interpersonal issues
- C. Ineffective coping skills
- D. Physiological stabilization
Correct Answer: D
Rationale: Self-concept and self-esteem problems may emerge during the client's treatment, but these are not immediate concerns. Interpersonal issues may become evident during the course of the client's treatment, but these are also not immediate areas of concern. Improving individual coping skills is generally a primary focus in the treatment and nursing care of persons with substance abuse problems. However, this is still not the immediate concern in this client situation. Correction of fluid and electrolyte status and vitamin deficiencies, as well as prevention of delirium, is the immediate concern in the care of this client.