Nokea
What should the nurse teach a client about how to avoid the dumping syndrome? Select all that apply.
- A. Consume three regularly-spaced meals per day.
- B. Eat a diet with high carbohydrate foods with each meal.
- C. Reduce fluids with meals, but take them between meals.
- D. Obtain adequate amounts of protein and fat in each meal.
- E. Eat in a relaxing environment.
Correct Answer: C,D,E
Rationale: To avoid dumping syndrome, clients should reduce fluids with meals, ensure adequate protein and fat, and eat in a relaxing environment. Three meals a day and high-carbohydrate foods can exacerbate symptoms.
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Which of the following assessments should be a priority immediately after nasal surgery?
- A. Assessing the client's pain.
- B. Inspecting for periorbital ecchymosis.
- C. Assessing respiratory status.
- D. Measuring intake and output.
Correct Answer: C
Rationale: Respiratory status is the priority post-nasal surgery due to the risk of airway obstruction from packing or swelling. Pain, ecchymosis, and fluid balance are important but secondary to airway patency.
The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes the cardiac rhythm shown on the electrocardiogram strip below. The nurse identifi es this rhythm as which of the following?
- A. Atrial fi brillation
- B. Ventricular tachycardia.
- C. Premature ventricular contractions (PVCs).
- D. Third-degree heart block.
Correct Answer: C
Rationale: PVCs are early depolarizations originating in the ventricles, and they present exactly as seen in your strip.
The charge nurse on a hematology/oncology unit is reviewing the policy for using abbreviations with the staff. The charge nurse should emphasize which of the following about why dangerous abbreviations need to be eliminated? Select all that apply.
- A. To ensure efficient and accurate communication.
- B. To prevent medication errors.
- C. To ensure client safety.
- D. To make it easier for clients to understand the medication orders.
- E. To make data entry into a computerized health record easier.
Correct Answer: A,B,C
Rationale: Eliminating dangerous abbreviations ensures clear communication, prevents medication errors, and enhances client safety by reducing misinterpretations. Client understanding and data entry ease are secondary benefits.
The client with rheumatoid arthritis tells the nurse, 'I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?' Which of the following responses by the nurse would be most appropriate?
- A. It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation.'
- B. Tell me more about your friend's arthritic condition. Maybe I can answer that question for you.'
- C. That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it.'
- D. Every person is different. What works for one client may not always be effective for another.'
Correct Answer: D
Rationale: Individual responses to treatments vary due to differences in disease severity, comorbidities, and side effect profiles. This response educates the client without dismissing their concerns.
Which activity increases the risk of renal calculi?
- A. High fluid intake.
- B. Sedentary lifestyle.
- C. Low-sodium diet.
- D. Frequent urination.
Correct Answer: B
Rationale: A sedentary lifestyle promotes urinary stasis, increasing stone risk.