Nokea
Which assessment tools can be used to assess the cardiac system (select all that apply)?
- A. Watch
- B. Stethoscope
- C. Ophthalmoscope
- D. Percussion hammer
Correct Answer: D
Rationale: The correct answers are 'Watch,' 'Stethoscope,' 'Percussion hammer,' and 'Blood pressure cuff.' These tools aid in evaluating heart rate, rhythm, sounds, and vascular status.
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What is first-line therapy for insomnia?
- A. Complementary therapies such as melatonin
- B. Cognitive-behavioral therapies such as relaxation therapy
- C. Benzodiazepine-receptor-like agents (e.g., zolpidem [Ambien])
- D. Over-the-counter medication such as diphenhydramine (Benadryl)
Correct Answer: B
Rationale: The correct answer is B. Cognitive-behavioral therapy (CBT) is the first-line treatment for insomnia due to its effectiveness and lack of side effects. Melatonin (A) and over-the-counter medications (D) are secondary options, while benzodiazepines (C) are reserved for short-term use.
In monitoring patients who are at risk for spinal cord compression related to tumor growth, what is the most likely early manifestation?
- A. Sudden-onset back pain.
- B. Motor loss.
- C. Constipation.
- D. Urinary hesitancy.
Correct Answer: A
Rationale: Sudden-onset back pain is often the first symptom of spinal cord compression and warrants urgent evaluation.
A client is postoperative following an intermaxillary fixation due to multiple facial fractures. Which type of equipment should be at the client's bedside?
- A. Wire cutters
- B. NG tube
- C. Urinary catheter tray
- D. IV infusion pump
Correct Answer: A
Rationale: The correct answer is A: Wire cutters. In postoperative intermaxillary fixation, wire cutters are essential at the bedside in case of an emergency airway obstruction or need for immediate removal of the fixation. Wire cutters allow quick access to the airway without causing harm to the client.
B: NG tube is not necessary for postoperative intermaxillary fixation.
C: Urinary catheter tray is not directly related to the client's airway or fixation.
D: IV infusion pump is not specifically required for managing intermaxillary fixation emergencies.
In summary, wire cutters are crucial for ensuring client safety and airway management in postoperative intermaxillary fixation, making it the most appropriate equipment to have at the bedside.
To prevent a common, adverse effect of prolonged use of phenytoin sodium (Dilantin), patients taking the drug are instructed to
- A. avoid crowds and obtain an annual influenza vaccination.
- B. drink at least 2 L of fluids daily, including 8 to 10 glasses of water.
- C. eat a potassium-rich, low-sodium diet.
- D. practice good dental hygiene and report gum swelling or bleeding.
Correct Answer: D
Rationale: Phenytoin can cause gum hyperplasia, so good dental hygiene is essential.
Which chief complaint is NOT desirable for recording on the client’s chart?
- A. CC: “cough and temperature elevation,” 2 days duration
- B. CC: “passing black stools,” 1 day duration
- C. CC: “substernal pain,” 2 hours duration
- D. Reason for contact: “physical examination for college”
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Chief complaints should be symptoms or concerns related to the client's health issues.
2. "Physical examination for college" is not a specific symptom or health concern.
3. Chief complaints guide healthcare providers in assessing and treating the client.
4. Recording irrelevant chief complaints can lead to confusion in diagnosis and treatment.
Summary of Incorrect Choices:
A: Describes specific symptoms, suitable for recording.
B: Describes a specific symptom (black stools), suitable for recording.
C: Describes a specific symptom (substernal pain), suitable for recording.