Nokea
Which of the ff. does the nurse understand are the reasons a patient with pulmonary edema is given morphine sulphate? i.To reduce anxiety iv.To increase BP ii.To relieve chest pain v.To reduce preload and afterload iii.To strengthen heart contractions
- A. 2 and 4
- B. 3 and 5
- C. 1 and 5
- D. 2 and 3
Correct Answer: C
Rationale: The correct answer is C because morphine sulfate is given to a patient with pulmonary edema to reduce anxiety (i) and to reduce preload and afterload (v). Morphine sulfate does not increase blood pressure (ii), relieve chest pain (iii), or strengthen heart contractions (iv) in the context of pulmonary edema. Choice A is incorrect because it includes increasing BP, which is not a reason for giving morphine sulfate in this case. Choice B is incorrect because it includes strengthening heart contractions, which is not a reason for administering morphine sulfate. Choice D is incorrect because it includes relieving chest pain, which is not a primary purpose of giving morphine sulfate to a patient with pulmonary edema.
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When evaluating the effectiveness of nursing interventions for sinusitis discomfort, which of the following does the nurse assess?
- A. WBC count
- B. Capillary refill
- C. Amount and color of sinus drainage
- D. Comfort level
Correct Answer: C
Rationale: The correct answer is C: Amount and color of sinus drainage. Assessing the amount and color of sinus drainage is crucial in evaluating the effectiveness of nursing interventions for sinusitis discomfort as it indicates the presence of infection or inflammation. Changes in color or amount can signify improvement or worsening of the condition. WBC count (A) may indicate infection but doesn't directly reflect sinusitis discomfort. Capillary refill (B) assesses circulation, not sinusitis. Comfort level (D) is subjective and can vary among individuals, making it less reliable for assessing the effectiveness of interventions.
The nurse is attempting to prompt the patient to elaborate on the reports of daytime fatigue. Which question should the nurse ask?
- A. “Is there anything that you are stressed about right now that I should know?”
- B. “What reasons do you think are contributing to your fatigue?”
- C. “What are your normal work hours?”
- D. “Are you sleeping 8 hours a night?”
Correct Answer: B
Rationale: The correct answer is B because it encourages the patient to reflect on the potential causes of their fatigue, leading to a more detailed and insightful response. This open-ended question allows the patient to explore various factors contributing to their fatigue, such as lifestyle habits, medical conditions, or emotional stressors.
Choice A focuses on stress, which may not be the primary cause of fatigue for the patient. Choice C is too specific and may not uncover other relevant information. Choice D assumes that sleep duration is the sole factor contributing to fatigue, neglecting other possible causes. Overall, choice B facilitates a more comprehensive discussion and helps the nurse gather valuable information to address the patient's concerns effectively.
Hypernatremia is associated with a:
- A. Serum osmolality of 245mOsm/kg
- B. Urine specific gravity below 1.003
- C. Serum sodium of 150mEq/L
- D. Combination of all of the above
Correct Answer: D
Rationale: Step 1: Hypernatremia is defined by elevated serum sodium levels (>145mEq/L).
Step 2: Serum osmolality of 245mOsm/kg is high, consistent with hypernatremia.
Step 3: Urine specific gravity below 1.003 indicates dilute urine, a common finding in hypernatremia.
Step 4: The combination of elevated serum sodium, high serum osmolality, and low urine specific gravity confirms hypernatremia.
Summary:
A: Incorrect, as high serum osmolality (not 245mOsm/kg) is associated with hypernatremia.
B: Incorrect, as low urine specific gravity (not below 1.003) is seen in hypernatremia.
C: Incorrect, as serum sodium needs to be >145mEq/L to indicate hypernatremia.
The nurse observes the client as he walks into the room. What information will this provide the nurse?
- A. Information regarding the client’s gait
- B. Information regarding the client’s personality
- C. Information regarding the client’s psychosocial status
- D. Information on the rate of recovery from surgery
Correct Answer: A
Rationale: The correct answer is A because observing the client's gait while walking can provide valuable information about their physical mobility, balance, coordination, and any potential musculoskeletal issues. This assessment helps the nurse determine if the client requires any assistance, mobility aids, or further evaluation by a healthcare provider. Choices B and C are incorrect as observing gait does not directly provide information on personality or psychosocial status. Choice D is incorrect as gait observation is not specifically related to the rate of recovery from surgery. In summary, observing the client's gait is important for assessing physical mobility and identifying potential issues, making it the most relevant choice in this context.
Which of the following procedures does the nurse understand is used to correct otosclerosis?
- A. Myringotomy
- B. Mastoidectomy
- C. Myringoplasty
- D. Stapedectomy
Correct Answer: D
Rationale: The correct answer is D: Stapedectomy. This procedure is used to correct otosclerosis by removing the stapes bone and replacing it with a prosthetic device. This restores normal hearing by allowing sound waves to travel through the ear properly. Myringotomy (A) is a procedure to drain fluid from the middle ear, not to correct otosclerosis. Mastoidectomy (B) is the removal of infected mastoid air cells, not related to otosclerosis. Myringoplasty (C) is a surgical procedure to repair a perforated eardrum, not used for otosclerosis. Stapedectomy is the most appropriate choice for correcting otosclerosis as it directly addresses the abnormal bone growth in the middle ear.