Nokea
When a family of an accident victim, who has been declared brain-dead, appears open to organ donation, what should the nurse do?
- A. Discourage them from deciding until their grief has eased
- B. Listen to their concerns and answer their questions truthfully
- C. Urge them to immediately sign the consent form
- D. Inform them that the body will not be available for a wake or funeral
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Which of the following vascular system changes result from aging?
- A. Increased peripheral resistance of the blood vessels
- B. Decreased blood flow
- C. Increased workload of the left ventricle
- D. All of the above
Correct Answer: D
Rationale: As individuals age, various changes occur in the vascular system. These changes include increased peripheral resistance of the blood vessels, decreased blood flow, and an increased workload of the left ventricle. Therefore, all the listed changes result from aging, making option D, 'All of the above,' the correct answer.
Parenteral penicillin can be administered as an:
- A. IM injection or an IV solution
- B. IV or an intradermal injection
- C. Intradermal or subcutaneous injection
- D. IM or a subcutaneous injection
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
When is the most appropriate time for obtaining a sputum specimen for culture?
- A. Early in the morning
- B. After the patient eats a light breakfast
- C. After aerosol therapy
- D. After chest physiotherapy
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler's position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?
- A. Encourage the patient to increase her fluid intake to 200 ml every 2 hours
- B. Place a humidifier in the patient's room
- C. Continue administering oxygen by high humidity face mask
- D. Perform chest physiotherapy on a regular schedule
Correct Answer: D
Rationale: Chest physiotherapy is the most effective intervention in cases of impaired gas exchange related to increased secretions. This technique helps mobilize and clear secretions from the airways, thereby improving gas exchange in the lungs. Placing a humidifier or administering oxygen by high humidity face mask may provide moisture but may not directly address the clearance of secretions. Encouraging increased fluid intake can help with hydration but may not address the underlying issue of impaired gas exchange due to secretions.
A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient's skin. The most appropriate nursing action would be to:
- A. Withhold the medication and notify the physician
- B. Administer the medication and notify the physician
- C. Administer the medication with an antihistamine
- D. Apply corn starch soaks to the rash
Correct Answer: A
Rationale: In this scenario, the appearance of a rash after administering penicillin, even in a patient with no known allergies, is concerning for a potential allergic reaction. The appropriate action for the nurse to take is to withhold the medication and notify the physician. This precaution is necessary to prevent further administration of a medication that may be causing an adverse reaction, as allergic reactions can range from mild to severe and require immediate intervention.