Which of the ff dietary recommendations should a nurse give to a client taking diuretics?
- A. Include potassium rich foods
- B. Avoid fruit and fruit juices
- C. Include protein rich foods
- D. Avoid dairy products
Correct Answer: A
Rationale: Diuretics are medications that help the body get rid of excess sodium and water through increased urine output. One common side effect of diuretics is the loss of potassium from the body. Therefore, it is important for clients taking diuretics to include potassium-rich foods in their diet to help maintain a healthy potassium level. Some examples of potassium-rich foods include bananas, oranges, potatoes, spinach, avocados, and tomatoes. By including these foods in their diet, clients taking diuretics can help prevent potassium deficiency and maintain overall health.
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Nurse Raymond is giving instructions to an elderly client on diabetic foot care. Which teaching is not part of foot care?
- A. wear comfortable shoes that fit well and protect your feet
- B. trim your toenails straight across and file edges with emery board
- C. wash your feet in hot water to keep feet soft
- D. wear shoes at the beach or on hot pavement
Correct Answer: C
Rationale: Washing your feet in hot water is not recommended for diabetic foot care as it can increase the risk of burns and skin damage due to reduced sensitivity and circulation in the feet. Instead, it is advised to wash your feet in warm water, not hot, and to thoroughly dry them, especially in between the toes, to prevent fungal infections.
The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?
- A. Organize nursing activities to allow for uninterrupted sleep.
- B. Allow the infant to sleep through feedings during the night.
- C. Wait for the infant to cry to show definite signs of hunger.
- D. Discourage parents from rocking the infant
Correct Answer: A
Rationale: Organizing nursing activities to allow for uninterrupted sleep is the most appropriate intervention to decrease cardiac demands in an infant with congestive heart disease (CHD). Providing a peaceful and quiet environment will help in conserving the infant's energy and reducing stress on the heart, ultimately decreasing cardiac demands. Interrupted sleep or inadequate rest can place additional strain on the infant's heart, leading to increased cardiac demands and potential complications. Prioritizing uninterrupted sleep will benefit the infant's overall cardiac function and well-being.
When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following?
- A. A single vessel arising from both ventricles
- B. Obstruction of blood flow from the left ventricle
- C. Obstruction of blood flow from the right ventricle
- D. Return of blood to the heart without entry to the left atrium
Correct Answer: C
Rationale: Pulmonic stenosis (PS) is a heart condition where there is obstruction or narrowing of the pulmonary valve, which is responsible for allowing blood to flow out of the right ventricle to the lungs for oxygenation. This obstruction leads to decreased blood flow from the right side of the heart to the lungs, causing increased pressure in the right ventricle. This can result in symptoms such as fatigue, shortness of breath, and possible heart murmurs. It is essential for Nurse Alex to educate Jessica's parents about the impact of this obstruction in the right ventricle and the importance of monitoring Jessica's symptoms and seeking appropriate medical care when needed.
Which of the following IV solutions is hypertonic?
- A. Normal saline
- B. 0.45% NaCl
- C. 5% dextrose in 0.9% NaCl
- D. 0.225% NaCl
Correct Answer: C
Rationale: A hypertonic solution has a higher concentration of solutes compared to the intracellular fluid. In this case, 5% dextrose in 0.9% NaCl is hypertonic because it has a higher osmolarity due to the combined effect of dextrose and sodium chloride. The dextrose contributes to the hypertonicity, making the overall solution more concentrated than the intracellular fluid.
Which nursing consideration is important when caring for a child with impetigo contagiosa?
- A. Apply topical corticosteroids to decrease inflammation.
- B. Carefully remove dressings so as not to dislodge undermined skin, crusts, and debris.
- C. Carefully wash hands and maintain cleanliness when caring for an infected child.
- D. Examine child under a Wood lamp for possible spread of lesions.
Correct Answer: C
Rationale: Carefully washing hands and maintaining cleanliness when caring for an infected child with impetigo contagiosa is important due to its highly contagious nature. Impetigo is a skin infection that is easily spread through direct contact with the lesions or with items contaminated by the infected person such as towels, clothing, or bedding. By washing hands and maintaining cleanliness, caregivers can help prevent the spread of infection to others and minimize the risk of re-infection to the child. This nursing consideration is crucial in managing impetigo and promoting the child's recovery.