Nokea
Which of the following salivary glands is located inferior and posterior to the mandible and produces serous saliva rich in enzymes?
- A. Parotid gland
- B. Sublingual gland
- C. Submandibular gland
- D. Submaxillary gland
Correct Answer: C
Rationale: The submandibular gland is located inferior and posterior to the mandible. It produces a mixed type of saliva, which is primarily serous (enzyme-rich) but also contains some mucous components. This gland plays a significant role in digestion, as its serous saliva contains enzymes such as amylase that help break down carbohydrates in the mouth before they reach the stomach.
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A patient is reluctant to undergo a recommended procedure due to fear of pain. What is the nurse's best approach to address this fear?
- A. Dismiss the patient's fear and assure them that the procedure will not be painful.
- B. Provide the patient with accurate information about pain management strategies and options.
- C. Ignore the patient's fear and proceed with scheduling the procedure.
- D. Tell the patient that fear of pain is irrational and unfounded.
Correct Answer: B
Rationale: The nurse's best approach to address the patient's fear of pain is to provide accurate information about pain management strategies and options. In doing so, the nurse can help alleviate the patient's concerns by empowering them with knowledge and potential solutions for managing pain during and after the procedure. By acknowledging the patient's fear and addressing it with practical information, the nurse can build trust, reduce anxiety, and create a more supportive and collaborative environment for the patient. Dismissing, ignoring, or invalidating the patient's fear would not be effective in addressing the underlying concerns and could potentially lead to increased distress and resistance to the recommended procedure.
Which of the following nursing actions should the nurse TEACH the patient's care giver regarding tracheostomy care?
- A. Remove the tracheostomy tube if obstruction occurs
- B. Leave the tracheostomy ties in place until the physician change them
- C. Remove and clean the inner cannula daily
- D. Never put a covering over the tracheostomy stoma
Correct Answer: C
Rationale: Cleaning the inner cannula daily helps prevent the accumulation of secretions and debris, which can lead to blockages and infections. It is an essential aspect of tracheostomy care to maintain the patency of the airway and prevent complications. Caregivers should be taught how to safely remove, clean, and reinsert the inner cannula as part of routine tracheostomy care.
Delegation is a critical component of leadership and governance. Which of the following empowering activities should the unit manager applies in delegation?
- A. In delegation facilitating professional growth and development of a staff is necessary.
- B. When delegating responsibility to a nursing staff, modification of standards of care is permitted.
- C. Delegation of responsibility in patient care has to start from top management to the staff-nurse level.
- D. Delegation requires responsibility with corresponding accountability of a staff-nurse.
Correct Answer: A
Rationale: In delegation, facilitating the professional growth and development of a staff is necessary because it allows team members to gain new skills and experience, leading to overall improved productivity and job satisfaction. This empowers staff and helps them feel more engaged in their work, ultimately benefiting the entire unit. Effective delegation should aim to support individuals in their roles, encourage learning, and build competence, rather than modifying standards of care or only delegating tasks without considering individual growth. Starting delegation from top management to staff-nurse level may not always be practical or efficient, as delegation should be based on competencies and responsibilities. Accountability is indeed a crucial aspect of delegation, as individuals should be held responsible for the tasks they are delegated. However, without providing opportunities for professional growth and development, delegation may not be as effective in achieving organizational goals.
Which assessment by the nurse would cause a concern for Meperidine Overdosed?
- A. Respiration rate of 12 bpm.
- B. Dryness of the skin.
- C. Hypercapnia
- D. Pinpoint pupils.
Correct Answer: C
Rationale: Meperidine (Demerol) is an opioid analgesic. Overdose of Meperidine can lead to respiratory depression, characterized by slow and shallow breathing. As a result of respiratory depression, hypercapnia, which is an increased level of carbon dioxide in the blood, can occur. This is a serious concern and requires immediate medical intervention to support respiratory function. Therefore, hypercapnia would be the assessment by the nurse that causes a concern for Meperidine overdose.
You have observed presence of drainage in Claudia's eyes. Which of the following eye solution would you use in cleaning her eyes?
- A. Hydrochloric acid
- B. Mineral water
- C. Normal saline solution
- D. Soapsuds solution
Correct Answer: C
Rationale: Normal saline solution is the best choice for cleaning Claudia's eyes with drainage. It is a sterile solution that closely matches the natural pH of the eyes, making it gentle and safe for ocular use. Normal saline can help flush out any debris or discharge in the eye without causing further irritation or complications. On the other hand, hydrochloric acid is a corrosive substance that can cause significant harm if it comes into contact with the eyes. Mineral water may contain impurities that could further irritate the eyes. Soapsuds solution is not recommended for eye cleaning as it can cause irritation and damage to the delicate eye tissues. Therefore, normal saline solution is the most appropriate and safe option for cleaning Claudia's eyes in this situation.