Nokea
When drawing up a dosage of subcutaneous heparin, how much air should be drawn into the syringe after the correct dosage is obtained?
- A. 1 mL
- B. 0.6 mL
- C. 0.2 to 0.3 mL
- D. 0.01 mL
Correct Answer: C
Rationale: An air lock of 0.2-0.3 mL (C) is used in subcutaneous heparin injections to ensure the full dose is delivered and to prevent leakage.
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The nurse is caring for a client with a malignancy. The classification of the primary tumor is Tis. The nurse should plan care for a tumor:
- A. That cannot be assessed
- B. That is in situ
- C. With increasing lymph node involvement
- D. With distant metastasis
Correct Answer: B
Rationale: Tis indicates a tumor in situ, meaning it is noninvasive and confined to its original site, requiring specific care planning.
All of the following statements regarding scarlet fever are true EXCEPT
- A. rheumatic fever is a possible complication of scarlet fever.
- B. scarlet fever can be treated with antibiotics.
- C. a vaccine is available to protect against scarlet fever.
- D. scarlet fever is caused by an erythrogenic toxin.
Correct Answer: C
Rationale: No vaccine exists for scarlet fever, which is caused by Streptococcus pyogenes’ erythrogenic toxin and treated with antibiotics. Rheumatic fever is a complication.
A client with COPD must have the arterial blood gas (ABG) test and asks the nurse to explain the purpose of the test. Which of the following information should the nurse include? Select all that apply.
- A. ABGs measure the levels of carbon dioxide, oxygen, and acidity in the blood.
- B. ABGs help to evaluate the effectiveness of treatment.
- C. ABGs measure the degree of anemia that has developed.
- D. ABGs can help to determine the need for supplemental oxygen.
Correct Answer: A,B,D
Rationale: ABGs measure CO2, O2, and pH (A), evaluate treatment efficacy (B), and guide oxygen therapy (D). Anemia (C) is assessed via hemoglobin, not ABGs.
The physician has prescribed Coumadin (sodium warfarin) for a client having transient ischemic attacks. Which laboratory test measures the therapeutic level of Coumadin?
- A. Prothrombin time
- B. Clot retraction time
- C. Partial thromboplastin time
- D. Bleeding time
Correct Answer: A
Rationale: Prothrombin time (PT/INR) measures the therapeutic level of warfarin, ensuring effective anticoagulation.
The nurse is caring for a 16-year-old female with second- and third-degree burns to the face, neck, chest, and arms. The client's wounds are almost healed. The nurse would expect rehabilitation to focus on problems related to:
- A. Body image disturbance
- B. Risk for infection
- C. Sensory perceptual alterations
- D. Activity intolerance
Correct Answer: A
Rationale: Burns to visible areas like the face and neck can significantly impact body image, especially in a teenager, making this a priority during rehabilitation as wounds heal.