Nokea
Which of the following dietary measures would be useful in preventing esophageal reflux?
- A. Eating small, frequent meals.
- B. Increasing fluid intake.
- C. Avoiding air swallowing with meals.
- D. Adding a bedtime snack to the dietary plan.
Correct Answer: A
Rationale: Small, frequent meals reduce gastric distention and lower the risk of reflux compared to large meals. The other options are less effective or may worsen symptoms.
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A 15-year-old client needs life-saving emergency surgery, but his relatives live an hour away from the hospital and cannot sign the consent form. What is the nurse's best response?
- A. Send the client to surgery without the consent.
- B. Call the family for a consent over the telephone and have another nurse listen as a witness.
- C. No action is necessary in this case because consent is not needed.
- D. Have the family sign the consent form as soon as they arrive.
Correct Answer: B
Rationale: For life-saving emergency surgery in a minor, telephone consent from the family with a witness is acceptable to meet legal requirements while expediting care.
A client is to receive glargine (Lantus) insulin in addition to a dose of aspart (NovoLog). When the nurse checks the blood glucose level at the bedside, it is greater than 200 mg/dL. How should the nurse administer the insulins?
- A. Put air into the glargine insulin vial, and then air into the aspart insulin vial, and draw up the correct dose of aspart insulin first.
- B. Roll the glargine insulin vial, then roll the aspart insulin vial. Draw up the longer-acting glargine insulin first.
- C. Shake both vials of insulin before drawing up each dose in separate insulin syringes.
- D. Add a little air to the glargine insulin vial and draw up the correct dose in an insulin syringe; then, with a different insulin syringe, put air into the aspart vial and draw up the correct dose.
Correct Answer: D
Rationale: Glargine and aspart insulins cannot be mixed. They should be drawn up in separate syringes to maintain their distinct actions (long-acting vs. rapid-acting). Shaking or rolling is inappropriate for glargine, which is clear.
Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible adverse effect of this drug?
- A. Constipation.
- B. Bradycardia.
- C. Diplopia.
- D. Restlessness.
Correct Answer: D
Rationale: Pseudoephedrine is a sympathomimetic that can cause central nervous system stimulation, leading to restlessness. Constipation, bradycardia, and diplopia are not common adverse effects of this medication.
The nurse is developing the discharge teaching plan for a client after a lumbar laminectomy L4-5 who will be returning to work in 6 weeks. Which of the following actions should the nurse encourage the client to avoid?
- A. Placing one foot on a stepstool during prolonged standing.
- B. Sleeping on the back with support under the knees.
- C. Maintaining average body weight for height.
- D. Sitting whenever possible.
Correct Answer: D
Rationale: Prolonged sitting can stress the surgical site and delay healing post-laminectomy.
A client is transferred to his room from the intensive care unit after a craniotomy for treatment of a malignant brain tumor in the occipital region. The nurse should question which of these orders?
- A. 400 mg of ibuprofen (Motrin).
- B. 500 mg of naproxen (Naprosyn).
- C. Morphine sulfate.
- D. Acetaminophen (Tylenol).
Correct Answer: A
Rationale: Ibuprofen (an NSAID) should be questioned post-craniotomy due to the risk of bleeding, which can be exacerbated by its antiplatelet effects in the context of recent brain surgery.