Nokea
Which of the following client statements indicates that the client with hepatitis B understands his discharge teaching?
- A. I will not drink alcohol for at least 1 year.'
- B. I must avoid sexual intercourse.'
- C. I should be able to resume normal activity in a week or two.'
- D. Because hepatitis B is a chronic disease, I know I will always be jaundiced.'
Correct Answer: A
Rationale: Avoiding alcohol for at least 1 year supports liver recovery in hepatitis B.
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A client with cirrhosis is admitted with ascites. The nurse should monitor the client for which of the following complications?
- A. Respiratory distress.
- B. Hyperkalemia.
- C. Hypoglycemia.
- D. Hypertension.
Correct Answer: A
Rationale: Ascites can cause diaphragmatic compression, leading to respiratory distress, which requires monitoring.
A client is receiving total parenteral nutrition (TPN). The nurse notices that the bag of TPN solution has been infusing for 24 hours but has $300 \mathrm{~mL}$ of solution left. The nurse should:
- A. Continue the infusion until the remaining 300mL is infused
- B. Change the filter on the tubing and continue with the infusion
- C. Notify the physician and obtain orders to alter the rate of the solution
- D. Discontinue the current solution, change the tubing, and hang a new bag of TPN solution
Correct Answer: D
Rationale: TPN solutions should not hang for more than 24 hours due to infection risk. The nurse should discontinue the current bag, change the tubing, and hang a new bag. Continuing or altering the rate is unsafe.
A parent reports that her child has developed a bloody nose. Which action should the nurse instruct the parent to take to control the bleeding?
- A. Pinch the nostrils for 5 minutes and then recheck for bleeding.
- B. Maintain the child in a sitting position with the head tilted backward.
- C. Lay the child down with a pillow tucked under the neck and stay with the child to keep the child calm.
- D. Have the child sit with the head tilted forward and hold pressure on the soft part of the nose for a period of 10 minutes.
Correct Answer: D
Rationale: The child should be positioned erect, sitting with head tilted forward to avoid blood dripping posteriorly to the pharynx. The soft part of the nose should be tightly pinched against the center wall for 10 minutes, and the parent should be instructed that this pinch should be timed by a clock, not estimated. The parent should be told not to release pressure for 10 minutes. The child is encouraged to remain calm and quiet and to breathe through the mouth.
A client on a psychiatric care unit approaches the nurse and complains of muscle spasms in his neck, stiffness in other muscles, and that his eyes are rolling upward. The client had two p.r.n. doses of haloperidol (Haldol) in the last 6 hours. Of the drugs that have been ordered for the client as needed (see chart), the nurse should administer:
- A. Lorazepam (Ativan).
- B. Amantadine (Symmetrel).
- C. Diphenhydramine (Benadryl).
- D. Benztropine (Cogentin).
Correct Answer: D
Rationale: Dystonic adverse effects of haloperidol, especially oculogyric crises, are painful and frightening. I.M. benztropine is the fastest and most effective drug for managing dystonia. Lorazepam is an antianxiety medication and is not effective for treatment of dystonia. Although amantadine and diphenhydramine can be used for extrapyramidal symptoms, oral medications do not work as quickly, and amantadine may worsen psychotic symptoms.
A client has been scheduled for a barium swallow (esophagography). The nurse determines that the client understands preprocedure instructions when the client states the intention to take which action before the test?
- A. Take all oral medications as scheduled.
- B. Eat a regular breakfast on the day of the test.
- C. Monitor own bowel movement pattern for constipation.
- D. Remove metal objects and jewelry, especially from the neck and chest area.
Correct Answer: D
Rationale: A barium swallow, or esophagography, is a radiograph that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal (GI) tract. The client is told to remove metal objects such as medals and jewelry before the test so that they will not interfere with radiographic visualization of the field. Some oral medications are withheld before the test, and the client should follow the primary health care provider's instructions regarding medication administration. The client should fast for a minimum of 8 hours before the test, depending on primary health care provider's instructions. It is important after the procedure to monitor for constipation, which can occur as a result of the presence of barium in the GI tract.