Nokea
Which dietary restriction is critical in acute renal failure?
- A. Low sodium.
- B. High protein.
- C. Low carbohydrate.
- D. High potassium.
Correct Answer: A
Rationale: Low sodium prevents fluid retention and hypertension in acute renal failure.
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A nurse teaches a client experiencing heartburn to take 1 ½ oz of Maalox when symptoms appear. How many milliliters should the client take?
Correct Answer: 45 mL
Rationale: To convert ounces to milliliters: 1.5 oz × 30 mL/oz = 45 mL. The client should take 45 milliliters of Maalox.
A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy?
- A. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions.
- B. Contact the physician to determine if an alternative examination could be scheduled.
- C. Provide a dose of acetaminophen (Tylenol).
- D. Cancel the examination because of the hard X-ray table.
Correct Answer: A
Rationale: Dividing the session into shorter ones reduces discomfort, advocating for the client's comfort while ensuring the test is completed.
The nurse is developing a care plan for a client with leukemia. The plan should include which of the following? Select all that apply.
- A. Monitor temperature and report elevation.
- B. Recognize signs and symptoms of infection.
- C. Avoid crowds.
- D. Maintain integrity of skin and mucous membranes.
- E. Take a baby aspirin each day.
Correct Answer: A,B,C,D
Rationale: Leukemia increases infection risk due to impaired immune function. Monitoring temperature, recognizing infection signs, avoiding crowds, and maintaining skin/mucous membrane integrity are critical to prevent and detect infections. Baby aspirin is not indicated and may increase bleeding risk in leukemia.
When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from:
- A. Insufficient secretion of growth hormone (GH).
- B. Dysfunction of the hypothalamic pituitary.
- C. Idiopathic atrophy of the adrenal gland.
- D. Oversecretion of the adrenal medulla.
Correct Answer: C
Rationale: Primary Addison's disease is caused by idiopathic adrenal gland atrophy, leading to deficient cortisol and aldosterone production.
What is the nurse's best action for a client with a migraine headache?
- A. Administer oxygen.
- B. Provide a quiet, dark environment.
- C. Encourage fluid restriction.
- D. Apply a warm compress.
Correct Answer: B
Rationale: A quiet, dark environment reduces stimuli that exacerbate migraine symptoms.