Nokea
What PRIORITY precautionary measure should be done by the nurse during the oxygen therapy?
- A. Limit visitors.
- B. Attach "No Smoking" signage
- C. Check humidifler's water regularly.
- D. Connect bait to oxygen tank.
Correct Answer: C
Rationale: Checking the humidifier's water regularly is the priority precautionary measure that should be done by the nurse during oxygen therapy. Maintaining adequate water in the humidifier ensures proper humidification of the oxygen delivered to the patient, helping prevent mucous membrane dryness and irritation. Dry mucous membranes can lead to discomfort, increased risk of infection, and potential damage to the respiratory system. Therefore, ensuring the humidifier's water level is appropriate is crucial for the safety and well-being of the patient receiving oxygen therapy. Limiting visitors, attaching "No Smoking" signage, and connecting the bait to the oxygen tank are important precautions as well, but checking the humidifier's water is the priority measure in this scenario.
You may also like to solve these questions
Nurse Harper provides health instruction to the patient experiencing heartburn, which statement by the patient indicates a NEED or further Instructions? I have to drink milk between meals it
- A. Drink milk between meals
- B. Eat small, frequent meals
- C. avoid fatty or spicy foods
- D. lie down after eating
Correct Answer: A
Rationale: This statement indicates a need for further instructions because drinking milk between meals may worsen heartburn for some individuals. Milk can temporarily neutralize stomach acid, but it can also stimulate acid production in the stomach leading to increased heartburn symptoms. Therefore, Nurse Harper should provide more guidance on appropriate dietary choices for managing heartburn, such as avoiding trigger foods like fatty or spicy foods, eating small, frequent meals, and not lying down immediately after eating.
In providing health teaching to the famil, Nurse Emma would include in her teachings the etioology of Scabies which is __________.
- A. virus
- B. bacteria
- C. fungi
- D. Parasite
Correct Answer: D
Rationale: Scabies is caused by an infestation of the microscopic mite Sarcoptes scabiei. This parasitic mite burrows into the upper layer of the skin, where it lays eggs and causes intense itching and skin irritation. The transmission of scabies usually occurs through close and prolonged skin-to-skin contact with an infested person. Unlike viruses, bacteria, and fungi, which are microorganisms that can also cause skin infections, scabies specifically refers to an infestation by a parasitic mite.
Signs such as using tissues to doorknobs develop because the patient is ________.
- A. unconsciously controlling unacceptable impulses or feelings
- B. Listening to voices that tell her that doorknobs are unclean
- C. consciously using this method of punishing herself
- D. fulfilling a need to punish others procedure by carrying out annoying
Correct Answer: A
Rationale: Signs such as using tissues to doorknobs suggest that the patient is unconsciously controlling unacceptable impulses or feelings. This behavior falls under the category of defense mechanisms, specifically displacement, where the individual redirects their emotions from a threatening target to a safer one. In this case, the patient may be experiencing anxiety or fear related to contamination or germs, leading them to use tissues to avoid touching doorknobs directly. It is a way for the patient to manage their underlying emotions, albeit unconsciously, through this compulsive behavior.
A patient admitted to the ICU develops acute renal failure requiring renal replacement therapy (RRT). What intervention should the healthcare team prioritize to initiate RRT?
- A. Insertion of a temporary hemodialysis catheter.
- B. Placement of a peritoneal dialysis catheter.
- C. Initiation of continuous renal replacement therapy (CRRT).
- D. Administration of loop diuretics to enhance urine output.
Correct Answer: C
Rationale: In a critically ill patient admitted to the ICU with acute renal failure requiring renal replacement therapy (RRT), the healthcare team should prioritize the initiation of continuous renal replacement therapy (CRRT). CRRT is preferred in critically ill patients with hemodynamic instability as it allows for slow and continuous removal of solutes and fluids, making it a safer option compared to intermittent hemodialysis. CRRT can also provide better control of volume status and electrolyte imbalances over a longer period, which is beneficial in critically ill patients who are hemodynamically unstable. Peritoneal dialysis is not commonly used in the ICU setting for acute renal failure requiring RRT, and loop diuretics are not effective in treating acute renal failure. Temporary hemodialysis catheters may also be used, but CRRT is generally preferred in critically ill patients for better hemodynamic tolerance and control of solute and fluid removal.
In a conscious trauma patient with a suspected head injury, which of the following actions is appropriate?
- A. Applying direct pressure to the wound.
- B. Administering aspirin for pain relief.
- C. Maintaining cervical spine immobilization.
- D. Assessing pupil reaction to light.
Correct Answer: C
Rationale: In a conscious trauma patient with a suspected head injury, maintaining cervical spine immobilization is crucial. The presence of a head injury raises concerns for potential concomitant cervical spine injury. Therefore, it is vital to prevent any movement of the cervical spine to avoid exacerbating a potential spinal cord injury. Maintaining immobilization involves stabilizing the patient's head and neck in a neutral position until appropriate imaging studies can assess the extent of any spinal injury. This action helps prevent further harm and ensures the safety of the patient during assessment and management of their injuries.