Nokea
When obtaining the diet history from a client with anemia, the nurse should include questions specifically about which of the following vitamins or minerals that are most likely missing in this client's diet? Select all that apply.
- A. Vitamin B6.
- B. Vitamin K.
- C. Vitamin B12.
- D. Iron.
- E. Vitamin C.
Correct Answer: C, D, E
Rationale: Anemia is commonly associated with deficiencies in vitamin B12, iron, and vitamin C (which aids iron absorption).
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A postoperative nursing goal for the infant who has had surgery to correct imperforate anus is to prevent tension on the perineum. To achieve this goal, the nurse should not place the neonate on the:
- A. Abdomen, with legs pulled up under the body.
- B. Back, with legs suspended at a 90-degree angle.
- C. Left side, with hips elevated.
- D. Right side, with hips elevated.
Correct Answer: A
Rationale: The abdominal position with legs tucked increases perineal tension, risking surgical site strain, unlike the other positions.
Select the arterial blood gas that you would report to the client's physician because it is not within normal parameters and it is also a significant change for the client.
- A. PaO2: 65 mm Hg
- B. PaCO2: 40 mm Hg
- C. Arterial blood pH: 7.39
- D. SaO2: 96%
Correct Answer: A
Rationale: PaO2 of 65 mm Hg is below the normal range (75-100 mm Hg), indicating hypoxemia, which requires reporting.
Place the following steps for mixing NPH and regular insulin in the proper sequential order from # 1 to # 6 below. #1 - Prep the top of the shorter acting insulin with an alcohol swab #2 - Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin syringe. #3 - Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe. #4 - Prep the top of the longer acting insulin vial with an alcohol swab. #5 - Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe. #6 - Withdraw the ordered dosage of the longer acting insulin using the same insulin syringe.
- A. 1,5,4,2,3,6
- B. 4,3,2,6, 1,5
- C. 4,2,5,3, 1,6
- D. 1,5,3,6,4,2
Correct Answer: A
Rationale: The correct sequence is: 1) Prep short-acting insulin vial, 2) Inject air into short-acting vial, 3) Withdraw short-acting insulin, 4) Prep long-acting insulin vial, 5) Inject air into long-acting vial, 6) Withdraw long-acting insulin to avoid contamination.
A client with a history of cirrhosis is admitted with ascites. Which dietary modification should the nurse recommend?
- A. Low-sodium diet
- B. High-protein diet
- C. Low-fat diet
- D. High-carbohydrate diet
Correct Answer: A
Rationale: A low-sodium diet reduces fluid retention in ascites, helping to manage symptoms in clients with cirrhosis.
A woman is being seen to confirm a possible pregnancy. When the nurse asks the woman how she has been feeling, which statement reflects the expected signs of pregnancy? Select all that apply.
- A. I have been so nauseous.
- B. I am having so much trouble with diarrhea.
- C. I have not had a menstrual period in 2 months.
- D. I have to go to the restroom to urinate all the time.
- E. I have been going to the health club regularly because I have so much energy.
Correct Answer: A,C,D
Rationale: Because the nurse is asking the woman, she would expect presumptive signs of pregnancy to be vocalized. Specifically the presumptive signs of pregnancy are nausea, vomiting, breast changes, amenorrhea, urinary frequency, fatigue, and quickening. Diarrhea is not a typical sign of early pregnancy, and increased energy is less common as fatigue is more typical.