Nokea
Which of the following statement is NOT true about standards of care?
- A. Guide nursing practice
- B. Based on evidence
- C. Vary by nurse
- D. Ensure quality
Correct Answer: C
Rationale: Standards guide practice (A), are evidence-based (B), ensure quality (D) 'vary by nurse' (C) isn't true, uniform, per regulation. C's variation contradicts consistency for Mr. Gary's care, making it untrue.
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All of the following characteristics would indicate to the nurse that an elder client might experience undesirable effects of medicines except:
- A. Increased oxidative enzyme levels
- B. Alcohol taken with medication
- C. Medications containing magnesium
- D. Decreased serum albumin
Correct Answer: A
Rationale: Oxidative enzyme levels decrease with age, not increase, affecting drug metabolism.
Mr. Gary, at 67, is reflecting on his life achievements. This is an example of which Erikson's stage?
- A. Trust vs. Mistrust
- B. Industry vs. Inferiority
- C. Identity vs. Role confusion
- D. Integrity vs. Despair
Correct Answer: D
Rationale: At 67, reflecting on achievements is Integrity vs. Despair (D) Erikson's late adulthood, assessing life's worth. Trust (A) is infancy, industry (B) childhood, identity (C) adolescence not age-appropriate. D fits reflection, making it correct.
A client has a new prescription for furosemide. Which of the following instructions should the nurse include during discharge teaching?
- A. Avoid foods high in potassium.
- B. Monitor weight daily.
- C. Take the medication with food.
- D. Increase salt intake.
Correct Answer: B
Rationale: Monitoring weight daily is crucial when taking furosemide to detect fluid retention or loss. Furosemide is a diuretic that helps the body get rid of excess water and salt through urine. Changes in weight can indicate fluid shifts, which could be a sign of inadequate response to the medication or worsening condition. Therefore, monitoring weight daily is essential to assess the effectiveness of furosemide therapy and detect any potential issues early on. Choices A, C, and D are incorrect. Avoiding foods high in potassium is more relevant for clients taking potassium-sparing diuretics, not furosemide. Taking furosemide with food is not necessary, as it can be taken with or without food. Increasing salt intake is contradictory to the purpose of furosemide, which aims to eliminate excess salt from the body.
During postoperative teaching following a hip arthroplasty, which instruction should the nurse include?
- A. Avoid lying on your operative side.
- B. Cross your legs at the ankles only.
- C. Place a pillow between your legs when turning.
- D. Avoid bending your hip more than 120 degrees.
Correct Answer: C
Rationale: The correct instruction for the nurse to include during postoperative teaching following a hip arthroplasty is to 'Place a pillow between your legs when turning.' Placing a pillow between the legs when turning is crucial as it helps prevent dislocation of the hip prosthesis. This position aids in maintaining proper alignment and stability, thereby reducing the risk of complications after hip arthroplasty surgery. Choices A, B, and D are incorrect because they do not directly address the specific action needed to protect the hip prosthesis and prevent complications.
A client has a new prescription for a low-fat diet. Which of the following foods should be recommended?
- A. Bacon
- B. Whole milk
- C. Chicken breast
- D. Cheese
Correct Answer: C
Rationale: When following a low-fat diet, it is essential to choose foods that are low in fat. Chicken breast is a lean protein source that is low in fat, making it a suitable option for a low-fat diet. Bacon, whole milk, and cheese are higher in fat content and should be avoided or limited in a low-fat diet. Bacon is high in saturated fat, whole milk contains significant amounts of fat, including saturated fat, and cheese is also high in fat. Therefore, these options are not ideal for a low-fat diet.