When taking the blood pressure of a client who has AIDS the nurse must;
- A. Wear a mask and gown
- B. Use barrier techniques
- C. Wash the hands thoroughly
Correct Answer: B
Rationale: When taking the blood pressure of a client with AIDS, it is important for the nurse to use barrier techniques to prevent the potential transmission of infection. This includes wearing gloves to protect against exposure to blood or other bodily fluids, using disposable blood pressure cuffs and stethoscopes, and ensuring proper hand hygiene before and after the procedure. Barrier techniques help minimize the risk of cross-contamination and protect both the healthcare provider and the client from potential infections.
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Which of the ff information should the nurse provide to clients who are prescribed rifampin?
- A. Take medication with meals
- B. Inform that contact lenses, if worn, may
- C. Avoid wearing glasses become colored
- D. Avoid tuna, aged cheese, and red wine
Correct Answer: B
Rationale: Rifampin is a medication known to cause harmless discoloration of bodily fluids, including tears and sweat. This discoloration can also affect contact lenses if worn by the individual taking rifampin. Therefore, it is important for the nurse to inform clients who are prescribed rifampin about this potential side effect to prevent any concerns or misunderstandings. It is advisable for clients to use glasses instead of contact lenses while taking rifampin to avoid this discoloration.
Another girl was bitten by a poisonous snake. All of the following are true except
- A. The victim of a snake bite should be made to exercise the bitten extremity to hasten circulation
- B. The bite of a poisonous snake is distinguished by two fang marks
- C. Immediate severe pain and swelling distinguished the bite of a poisonous snake
- D. The tourniquet should be tight enough to prevent superficial circulation of blood thus stopping absorption of the poison
Correct Answer: A
Rationale: When it comes to snake bites, one should not exercise the bitten extremity as it can increase the spread of venom in the body. Moving the affected limb can potentially lead to the venom spreading more quickly through the lymphatic system and into the bloodstream. Therefore, it is essential to keep the victim as calm and still as possible to minimize the effects of the venom. Proper first aid for snake bites includes keeping the victim calm, immobilizing the bitten limb, and seeking immediate medical attention.
The ff are the tonometer measurements of five clients. Which of them has normal intraocular pressure (IOP)? Choose all that apply
- A. 8 mm Hg
- B. 25 mm Hg
- C. 11 mm Hg
- D. 28 mm Hg
Correct Answer: C
Rationale: Normal intraocular pressure (IOP) typically ranges between 10 and 21 mm Hg. For this reason, the tonometer measurements of 11 mm Hg and 20 mm Hg fall within the normal range. Therefore, clients with these IOP values (Option C and E) have normal intraocular pressure. The other options (A, B, and D) are outside the normal range for IOP and are therefore considered elevated.
Which of the ff is an important nursing intervention for HIV positive clients?
- A. Suggesting the use of herbal medications and alternative therapies
- B. Suggesting the use of psychostimulants such as methamphetamine
- C. Advising the client to avoid clinical drug trials
- D. Providing referral to support groups and resources for information
Correct Answer: D
Rationale: For HIV positive clients, one of the most important nursing interventions is to provide referral to support groups and resources where they can find emotional support, information, and guidance. Support groups can offer a sense of community, a safe space to share experiences, and practical advice on living with HIV. These groups can also provide valuable resources on managing HIV, accessing treatment, and coping with any associated stigma or discrimination. By connecting HIV positive clients to support groups and resources, nurses can help them navigate the challenges of living with HIV and promote their overall well-being and quality of life. This intervention fosters a holistic approach to care that goes beyond just medical treatment to address the social, emotional, and psychological needs of the client.
If a Wall unit is used, What should be the suctioning pressure required by James?
- A. 50-95 mmHg
- B. 100-120 mmHg
- C. 95-110 mmHg
- D. 155-175 mmHg
Correct Answer: A
Rationale: The recommended suction pressure range for suctioning an adult patient using a wall unit is typically between 80-120 mmHg. However, for a pediatric patient, the recommended suction pressure range is lower, usually between 50-95 mmHg. In this case, James' age is specified, so it is crucial to consider the appropriate suction pressure range for pediatric patients. Therefore, the suctioning pressure required by James should be in the range of 50-95 mmHg, making option A the correct answer.