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Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile?
- A. Teach the patient about proper food storag
- C. Order a diet without dairy products for the patient.
- D. Place the patient in a private room on contact isolation.
Correct Answer: D
Rationale: The correct answer is D: Place the patient in a private room on contact isolation. This is important because Clostridium difficile is highly contagious, spread through contact with infected feces. Isolating the patient helps prevent the spread. A: Teaching about food storage is irrelevant to managing C. difficile. B: Administering medications is not mentioned in the question. C: Ordering a diet without dairy is not the priority; isolation is key to prevent transmission.
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Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?
- A. Take the patient's apical pulse.
- B. Check the patient's blood pressure.
- C. Ask the patient about dietary intake.
- D. Dipstick the patient's urine for protein.
Correct Answer: B
Rationale: The correct answer is B: Check the patient's blood pressure. Monitoring blood pressure is crucial in determining if an obese patient has metabolic syndrome, as high blood pressure is one of the key criteria for diagnosing metabolic syndrome. Elevated blood pressure is a common feature of metabolic syndrome and is linked to other risk factors such as obesity, insulin resistance, and dyslipidemia. By checking the patient's blood pressure, the nurse can assess if the patient meets the criteria for metabolic syndrome.
Choice A (Take the patient's apical pulse) is not directly related to diagnosing metabolic syndrome. Choice C (Ask the patient about dietary intake) may provide important information but does not specifically help in diagnosing metabolic syndrome. Choice D (Dipstick the patient's urine for protein) is not a relevant assessment for determining metabolic syndrome.
A client with ulcerative colitis, who experiences severe diarrhea, is prescribed a cleansing enema to relieve the symptoms. Which of the following interventions should the nurse consider at this stage?
- A. Question the physician about the use of the cleansing enema
- B. Educate the client about the procedure of cleansing enema
- C. Position the client comfortably to receive the cleansing enema
- D. Instruct the client to visit the toilet before receiving the enema
Correct Answer: A
Rationale: The correct answer is A: Question the physician about the use of the cleansing enema. In this scenario, the nurse should question the physician because administering a cleansing enema to a client with ulcerative colitis and severe diarrhea can potentially exacerbate the condition. The nurse needs to verify if the enema is the appropriate intervention and if there are alternative treatments that may be safer and more effective.
Summary:
- Choice B: Educating the client about the procedure does not address the potential risks of administering the enema.
- Choice C: Positioning the client comfortably is important but does not address the appropriateness of the enema.
- Choice D: Instructing the client to visit the toilet before the enema does not address the potential risks associated with the procedure.
Cholesterol is a major component of atherosclerotic plaque. Cholesterol carried by ______ is linked to coronary heart disease.
- A. micelle
- B. chylomicron
- C. low-density lipoprotein (LDL)
- D. high-density lipoprotein (HDL)
Correct Answer: C
Rationale: The correct answer is C: low-density lipoprotein (LDL). LDL is often referred to as "bad cholesterol" because it carries cholesterol from the liver to the cells, leading to the buildup of plaque in the arteries, which can result in coronary heart disease. Micelles are small lipid structures, not carriers of cholesterol. Chylomicrons are large lipoprotein particles that transport dietary fats, not primarily cholesterol. HDL is known as "good cholesterol" as it helps remove cholesterol from the bloodstream back to the liver for excretion, reducing the risk of atherosclerosis.
What is the function of the enteric nervous system?
- A. controlling voluntary movements
- B. regulating hormone secretion
- C. controlling digestion independently of the brain
- D. controlling respiratory functions
Correct Answer: C
Rationale: The correct answer is C because the enteric nervous system is a complex network of neurons that controls digestion independently of the brain. It regulates gastrointestinal functions such as peristalsis, secretion of digestive enzymes, and blood flow. This system can operate autonomously but is also influenced by the central nervous system. Choices A, B, and D are incorrect because the enteric nervous system is not responsible for controlling voluntary movements, regulating hormone secretion, or controlling respiratory functions.
You would be most concerned about which client having an order for TPN (total parenteral nutrition) fat emulsion?
- A. A client with gastrointestinal obstruction
- B. A client with severe anorexia nervosa
- C. A client with chronic diarrhea and vomiting
- D. A client with a fractured femur
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. TPN fat emulsion can increase the risk of fat embolism in clients with fractures.
2. Fat embolism is a serious complication in clients with long bone fractures, like a fractured femur.
3. Clients with gastrointestinal issues, anorexia nervosa, chronic diarrhea, or vomiting are not at increased risk for fat embolism.
4. Monitoring for signs of fat embolism is crucial in clients receiving TPN fat emulsion to prevent complications.