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Which information should the nurse give a mother regarding the introduction of solid foods during infancy?
- A. Solid foods should not be introduced until 8 to 10 months, when the extrusion reflex begins to disappear.
- B. Foods should be introduced one at a time, at intervals of 4 to 7 days.
- C. Solid foods can be mixed in a bottle to make the transition easier for the infant.
- D. Fruits and vegetables should be introduced into the diet first.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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Parents of a newborn ask the nurse why vitamin K is being administered. The nurse accurately responds by explaining phytonadione (vitamin K) is administered to the newborn to:
- A. prevent bleeding.
- B. enhance immune response.
- C. prevent bacterial infection.
- D. maintain nutritional status.
Correct Answer: A
Rationale: Vitamin K is essential for the production of clotting factors in the liver. Newborns have lower levels of vitamin K and may not have a fully functioning clotting system, putting them at risk for bleeding disorders such as vitamin K deficiency bleeding (VKDB). Administering vitamin K to newborns helps prevent these bleeding issues and ensures proper clotting function. It does not have a direct effect on enhancing the immune response, preventing bacterial infections, or maintaining nutritional status, as its primary function in this context is to prevent bleeding disorders.
The client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?
- A. Sodium level of 140 mEq/l.
- B. Direct bilirubin level of 2 mg/dl
- C. Prothrombin time of 12 seconds
- D. Platelet count of 400,000/mm3
Correct Answer: B
Rationale: Acetaminophen toxicity can lead to hepatic injury, resulting in elevated liver enzymes, including bilirubin levels. Direct bilirubin is a specific marker for liver function and is typically elevated in cases of acetaminophen overdose or toxicity. Therefore, a direct bilirubin level of 2 mg/dl would indicate toxicity associated with acetaminophen use. Monitoring liver function tests, including bilirubin levels, is crucial when using acetaminophen long-term to prevent toxicity and liver damage.
Which nursing interventions can help prevent falls in a patient with Parkinson's disease? Choose all answers that are correct. i.Keep the patient's call light within reach ii.Apply a soft vest restraint when the patient is in bed iii.Avoid use of throw rugs iv.Maintain the patient's bed in a low position v.Encourage the patient to be independent for as long as possible vi.Provide a cane or walker for ambulation
- A. 1, 4, 2005
- B. 1, 3, 4, 6
- C. 2, 3, 2006
- D. 2, 4, 5, 6
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
An elderly client develops severe bone marrow depression from chemotheraphy for cancer of the prostate. The nurse should;
- A. Monitor Intake and output of fluids
- B. Increase dally intake of fluids
- C. Use a soft toothbrush for oral hygiene HEMATOPOIETIC AND LYMPHATIC SYSTEMS
Correct Answer: A
Rationale: Monitoring intake and output of fluids is essential for an elderly client who develops severe bone marrow depression from chemotherapy for prostate cancer. Bone marrow depression can result in decreased production of blood cells, including red blood cells, white blood cells, and platelets. Monitoring intake and output of fluids helps assess hydration status and kidney function. Decreased fluid intake or output may indicate kidney damage or dehydration, which are common concerns in clients with bone marrow depression. Therefore, it is crucial for the nurse to monitor the client's fluid balance closely to ensure optimal functioning of the kidneys and prevent complications related to bone marrow suppression.
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.