Nokea
Three days after admission Ms. CC continued to have frequent stools. Her oral intake of both fluids and solids are poor. Her physician ordered parenteral hyperalimentation. Hyperalimentation solutions are:
- A. Hypotonic solutions used primarily to increase osmotic pressure of blood plasma
- B. Hypertonic solutions used primarily for hydration when hemoconcentration is present
- C. Alkalizing solutions used to treat metabolic acidosis thus reducing cellular sweating
- D. Hyperosmolar solutions used primarily to reverse negative nitrogen balance
Correct Answer: D
Rationale: Hyperalimentation solutions are hypertonic or hyperosmolar solutions used to provide complete nutrition intravenously when a patient is unable to receive adequate nutrition orally. These solutions contain a high concentration of glucose, amino acids, electrolytes, and essential vitamins and minerals. They are used to reverse negative nitrogen balance, provide adequate caloric intake, and promote healing and recovery in patients who are unable to eat or absorb nutrients properly. Hyperalimentation solutions are not used to increase the osmotic pressure of blood plasma (Choice A), for hydration when hemoconcentration is present (Choice B), or to treat metabolic acidosis (Choice C).
You may also like to solve these questions
A client who is HIV positive should have the mouth examined for which oral problem common associated with AIDS?
- A. Halitosis
- B. Creamy white patches
- C. Carious teeth
- D. Swollen lips
Correct Answer: B
Rationale: A client who is HIV positive should have the mouth examined for oral thrush, which presents as creamy white patches on the tongue or lining of the mouth. Oral thrush, caused by the fungus Candida albicans, is a common oral problem associated with AIDS. It is important to detect and treat oral thrush promptly in HIV-positive individuals as it can cause discomfort, difficulty swallowing, and further complications if left untreated. Regular oral examinations and proper oral hygiene practices are essential for managing oral health in individuals living with HIV/AIDS.
Which is the most common causative agent of bacterial endocarditis?
- A. Staphylococcus albus
- B. Streptococcus hemolyticus
- C. Staphylococcus albicans
- D. Streptococcus viridans
Correct Answer: D
Rationale: Streptococcus viridans is the most common causative agent of bacterial endocarditis. This group of bacteria consists of various species, including S. sanguinis and S. mutans, which normally reside in the oral cavity and are commonly associated with endocarditis following dental procedures. Streptococcus viridans can enter the bloodstream due to dental work, oral infections, or trauma to the oral tissues, and cause infective endocarditis by adhering to damaged heart valves or endocardium. Staphylococcus aureus and Enterococcus species are other common pathogens associated with endocarditis, but Streptococcus viridans remains the most prevalent causative agent.
An adult has a central venous line. Which of the following should the nurse include in the plan of care?
- A. Complete blood count and electrolytes
- B. Regular chest x rays to ensure proper placement of the central line
- C. Continuous infusion of the solution at a keep vein open rate
- D. Any signs of infection, air embolus, and leakage or puncture
Correct Answer: D
Rationale: An adult with a central venous line should include monitoring for any signs of infection, air embolus, and leakage or puncture in the plan of care. Central venous lines carry a risk of complications such as infection, air embolism, and mechanical issues like leakage or puncture. These complications can be serious and require immediate attention to prevent further harm to the patient. Regular monitoring and assessment for these potential issues are crucial in providing safe care for a patient with a central venous line. Other options (A, B, C) may be important in the overall care but monitoring for complications is the priority.
The parent of a 2-week-old infant, exclusively breastfed, asks the nurse if fluoride supplements are needed. What is the nurse's best response?
- A. "She needs to begin taking them now."
- B. "They are not needed if you drink fluoridated water."
- C. "She may need to begin taking them at age 4 months."
- D. "She can have infant cereal mixed with fluoridated water instead of supplements."
Correct Answer: B
Rationale: The nurse's best response to the parent of a 2-week-old infant, exclusively breastfed, regarding the need for fluoride supplements is that they are not needed if the infant is already drinking fluoridated water. Fluoride supplements are typically recommended for infants who are not receiving enough fluoride through their water source. Breast milk itself does not contain a significant amount of fluoride, but if the family's water supply is fluoridated, the infant will likely receive an adequate amount of fluoride without the need for supplements. It is important for the parent to verify the fluoride content of their water supply with their local water utility to ensure the infant is receiving the appropriate amount of fluoride for dental health.
A nursing intervention for anemia is:
- A. Medical therapy
- B. High protein, vitamin and iron diet
- C. Fluid therapy
- D. Chemotherapy
Correct Answer: B
Rationale: Anemia is a condition characterized by a low red blood cell count or insufficient hemoglobin levels, resulting in decreased oxygen-carrying capacity in the blood. One of the nursing interventions for anemia is to promote a high protein, vitamin, and iron diet. Iron is essential for the production of hemoglobin, which carries oxygen in the blood. Including foods rich in iron, such as lean meats, dark leafy greens, beans, and fortified cereals, can help boost iron levels in the body. Additionally, consuming foods high in vitamin C can also aid in iron absorption. Protein is crucial for overall health and plays a role in red blood cell production. By encouraging a nutrient-rich diet, nurses can help support the body's ability to replenish its red blood cell supply and improve the symptoms associated with anemia.