Nokea
Which clients can be assigned to share a room in the emergency department during a disaster?
- A. A client having auditory hallucinations and a client with ulcerative colitis
- B. A client who is pregnant and a client with a fractured arm
- C. A child who is cyanotic with severe dyspnea and a client with a frontal head injury
- D. A client who arrives with a large puncture wound to the abdomen and a client with chest pain
Correct Answer: B
Rationale: A pregnant client and a client with a fractured arm have stable non-infectious conditions suitable for sharing a room. The other pairs include clients with unstable (cyanosis abdominal wound chest pain) or infectious (MRSA) conditions or psychiatric issues requiring isolation.
You may also like to solve these questions
A client is being discharged with albuterol (Proventil) and beclomethasone dipropionate (Vanceril) to be administered via inhalation three times a day and at bedtime. Client teaching regarding the sequential order in which the drugs should be administered includes:
- A. Glucocorticoid followed by the bronchodilator
- B. Bronchodilator followed by the glucocorticoid
- C. Alternate successive administrations
- D. According to the client's preference
Correct Answer: B
Rationale: The client would not receive therapeutic effects of the glucocorticoid when it is inhaled through constricted airways. Bronchodilating the airways first allows for the glucocorticoid to be inhaled through open airways and increases the penetration of the steroid for maximum effectiveness of the drug. Inaccurate use of the inhalers will lead to decreased effectiveness of the treatment. Client teaching regarding the use and effects of inhalers will promote client understanding and compliance.
A male client has been hospitalized with congestive heart failure. Medical management of heart failure focuses on improving myocardial contractility. This can be achieved by administering:
- A. Digoxin (Lanoxin) 0.25 mg po every day
- B. Furosemide (Lasix) 40 mg po every morning
- C. O2 2 L/min via nasal cannula
- D. Nitroglycerin (Nitrol) 1 inch topically every 4 hours
Correct Answer: A
Rationale: Digoxin enhances myocardial contractility, improving cardiac output in heart failure.
The nurse is caring for a client with a diagnosis of oligohydramnios. Which finding is most likely to be present?
- A. Decreased fetal movement
- B. Increased fetal heart rate
- C. Uterine size larger than expected
- D. Fetal macrosomia
Correct Answer: A
Rationale: Oligohydramnios (low amniotic fluid) can restrict fetal movement due to limited space making decreased fetal movement a likely finding. Fetal heart rate may be normal or show distress uterine size is smaller and macrosomia is unrelated.
A client with a history of trigeminal neuralgia is admitted with complaints of facial pain. The nurse should give priority to:
- A. Administering analgesics
- B. Monitoring blood pressure
- C. Providing a quiet environment
- D. Administering oxygen
Correct Answer: A
Rationale: Trigeminal neuralgia causes severe facial pain, so administering analgesics is the priority to relieve discomfort.
A 1-year-old child is to receive an IM injection ordered by his pediatrician. He has fallen asleep in his mother's arms when the nurse approaches. Which approach is most appropriate at this time?
- A. Give the injection in the vastus lateralis site before the child awakens.
- B. Awaken the child first and give the injection in the ventrogluteal site.
- C. Awaken the child first and give the injection in the dorsogluteal site.
- D. Ask the mother to place the child on the examination table and leave the room, and then give the injection in an appropriate site.
Correct Answer: B
Rationale: If awakened first, the child will know that nothing painful will be done without the child being alerted. The ventrogluteal site is a safe site for children because it is a large muscle free of major nerves and blood vessels. The dorsogluteal site is not recommended in children who have not been walking for at least 1 year because the muscle is not fully developed. The parent will be able to offer support and comfort during and after the injection.