Nokea
Which mind-body medicine technique allows an individual to voluntarily control physiologic functions such as body temperature, heart rate, blood pressure, and brain waves?
- A. Biofeedback
- B. Hypnosis
- C. Imagery
- D. Humor
Correct Answer: A
Rationale: Biofeedback enables individuals to gain conscious control over involuntary physiological processes.
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Priority Decision: A terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities. The patient’s husband and two grown children are arguing at the bedside about where the patient’s funeral should be held. What should the nurse do first?
- A. Ask the family members to leave the room if they are going to argue.
- B. Take the family members aside and explain that the patient may be able to hear them.
- C. Tell the family members that this decision is premature because the patient has not yet died.
- D. Remind the family that this should be the patient’s decision and to ask her if she regains consciousness.
Correct Answer: B
Rationale: The patient may still be able to hear even if unresponsive, so the nurse should gently remind the family of this to maintain respect for the patient's dignity and provide emotional support.
Denise is recovering from an open cholecystectomy. You know that because of the location of the surgery, she has an increased chance of postoperative
- A. Myocardial infarction.
- B. Respiratory complications.
Correct Answer: B
Rationale: Abdominal surgeries can increase the risk of respiratory complications due to reduced lung expansion.
On the first postoperative day following a bowel resection, the patient complains of abdominal and incisional pain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2 hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse’s action have on the patient?
- A. Protects the patient from addiction and toxic effects of the drug
- B. Prevents hastening or causing a patient’s death from respiratory dysfunction
- C. Contributes to unnecessary suffering and physical and psychosocial dysfunction
- D. Indicates that the nurse understands the adage of “start low and go slow” in administering analgesics
Correct Answer: C
Rationale: The correct answer is C. Delaying pain relief contributes to unnecessary suffering and can negatively impact recovery.
A client in the emergency department is being cared for by a nurse and has cardiogenic pulmonary edema. The client's assessment findings include anxiousness, dyspnea at rest, crackles, blood pressure 110/79 mm Hg, and apical heart rate 112/min. What is the nurse's priority intervention?
- A. Provide the client with supplemental oxygen at 5 L/min via facemask.
- B. Place the client in high-Fowler's position with their legs in a dependent position
- C. Give the client sublingual nitroglycerin
- D. Administer morphine sulfate IV
Correct Answer: A
Rationale: The correct answer is A: Provide the client with supplemental oxygen at 5 L/min via facemask. In cardiogenic pulmonary edema, the priority intervention is to improve oxygenation. Supplemental oxygen helps increase oxygen levels and alleviate respiratory distress, reducing the workload on the heart. This intervention addresses the client's dyspnea and anxiousness by improving oxygen delivery.
Choice B is incorrect as placing the client in high-Fowler's position with legs in a dependent position can help with breathing but does not address the immediate need for oxygenation.
Choice C is incorrect as sublingual nitroglycerin is typically used for angina and not the priority intervention for cardiogenic pulmonary edema.
Choice D is incorrect as morphine sulfate IV may be indicated for pain relief and anxiety, but it is not the priority intervention to address the client's oxygenation needs in cardiogenic pulmonary edema.
During seizure activity which observation is the priority to enhance further direction of treatment?
- A. Observe the sequence or types of movement.
- B. Note the time from beginning to end.
- C. Identify the pattern of breathing.
- D. Determine if loss of bowel or bladder control occurs.
Correct Answer: B
Rationale: Timing seizures is crucial for determining appropriate interventions.