Nokea
When preparing the client with hepatitis A for extended convalescence, the nurse teaches the client about problems that may occur. The nurse knows that the client has understood the teaching when he says that he is most likely to have difficulty:
- A. Controlling abdominal pain.
- B. Maintaining a regular bowel elimination pattern.
- C. Preventing respiratory complications.
- D. Maintaining a positive, optimistic outlook.
Correct Answer: D
Rationale: The correct answer is D: Maintaining a positive, optimistic outlook. This is because having a positive mindset can help the client cope better with the challenges of extended convalescence. It can improve overall well-being, mental health, and motivation for recovery.
A: Controlling abdominal pain - While abdominal pain may be a symptom of hepatitis A, it is not the most crucial aspect for extended convalescence.
B: Maintaining a regular bowel elimination pattern - While important for overall health, this is not specifically related to complications from hepatitis A.
C: Preventing respiratory complications - While respiratory complications can occur in severe cases of hepatitis A, it is not the most likely difficulty the client will face during extended convalescence.
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The nurse has inserted a nasogastric tube to the level of the oropharynx and has repositioned the client's head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts slowly to advance the nasogastric tube with each swallow. The client begins to cough, gag, and choke. Which nursing action would least likely result in proper tube insertion and promote client relaxation?
- A. Continuing to advance the tube to the desired distance
- B. Pulling the tube back slightly
- C. Checking the back of the pharynx using a tongue blade and flashlight.
- D. Instructing the client to breathe slowly and take sips of water.
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. The client is experiencing coughing, gagging, and choking, indicating improper tube insertion.
2. Continuing to advance the tube can lead to further discomfort and potential complications.
3. Pulling the tube back slightly allows for reevaluation of placement and prevents further irritation.
4. Checking the back of the pharynx can identify any obstruction or incorrect placement.
5. Instructing the client to breathe slowly and take sips of water can help relax the client and facilitate proper insertion.
A nurse is reviewing the results of serum laboratory studies drawn on a client who is suspected of having hepatitis. The nurse interprets that an elevation in which of the following studies is the most specific indicator of the disease?
- A. Erythrocyte sedimentation rate
- B. Serum bilirubin
- C. Hemoglobin
- D. Blood urea nitrogen
Correct Answer: C
Rationale: The correct answer is C: Hemoglobin. In hepatitis, there is destruction of red blood cells, leading to decreased hemoglobin levels. This is a specific indicator of the disease. The other choices are incorrect because A (ESR) is a nonspecific marker of inflammation, B (serum bilirubin) is elevated in liver dysfunction but not specific to hepatitis, and D (BUN) is a measure of kidney function, not related to hepatitis. Hemoglobin, being directly affected by the disease process in hepatitis, is the most specific indicator among the options provided.
The nurse assesses the client's understanding of the relationship between body position and gastroesophageal reflux. Which response would indicate that the client understands measures to avoid problems with reflux while sleeping?
- A. I can elevate the foot of the bed 4 to 6 inches.
- B. I can sleep on my stomach with my head turned to the left.
- C. I can sleep on my back without a pillow under my head.
- D. I can elevate the head of the bed 4 to 6 inches.
Correct Answer: D
Rationale: The correct answer is D: "I can elevate the head of the bed 4 to 6 inches." Elevating the head of the bed helps to prevent gastroesophageal reflux by promoting gravity to keep stomach acid from moving back into the esophagus. This position helps to keep the stomach contents in place and reduces the likelihood of reflux during sleep.
Choice A is incorrect because elevating the foot of the bed would not be effective in preventing reflux; it may even exacerbate the issue. Choice B is incorrect as sleeping on the stomach can increase pressure on the stomach and worsen reflux. Choice C is also incorrect as sleeping on the back without a pillow under the head may not provide the necessary elevation to prevent reflux effectively.
A client who has had gastrectomy is not producing sufficient intrinsic factor. The nurse interprets that the client has lost the ability to absorb cyanocobalamin (vitamin B12) in the
- A. Stomach.
- B. Small intestine.
- C. Large intestine.
- D. Colon.
Correct Answer: B
Rationale: The correct answer is B: Small intestine. After a gastrectomy, where the stomach is removed or bypassed, intrinsic factor production is reduced, impacting the absorption of vitamin B12. Intrinsic factor is necessary for the absorption of B12 in the small intestine, specifically in the ileum. If vitamin B12 is not absorbed in the small intestine, it can lead to pernicious anemia. Therefore, the small intestine is crucial for the absorption of vitamin B12 in the absence of intrinsic factor. Choices A, C, and D are incorrect as the stomach, large intestine, and colon do not play a significant role in the absorption of vitamin B12.
Which of the following activities should the nurse encourage the client with a peptic ulcer to avoid?
- A. Chewing gum.
- B. Smoking cigarettes.
- C. Eating chocolate.
- D. Taking acetaminophen (Tylenol).
Correct Answer: B
Rationale: The correct answer is B: Smoking cigarettes. Smoking can increase stomach acid production and decrease blood flow to the stomach lining, which can worsen peptic ulcers. Chewing gum can actually help by increasing saliva production, which can neutralize stomach acid. Eating chocolate and taking acetaminophen are generally safe for peptic ulcer patients as long as they do not have specific allergies or sensitivities.