Nokea
Why is a client with ascites scheduled for a paracentesis procedure?
- A. To diagnose liver disease
- B. To relieve abdominal pressure
- C. To assess kidney function
- D. To reduce blood pressure
Correct Answer: B
Rationale: The correct answer is B: To relieve abdominal pressure. Paracentesis is performed to drain excess fluid from the abdominal cavity, which helps alleviate symptoms like abdominal distension and discomfort in clients with ascites. It does not serve the purpose of diagnosing liver disease (A), assessing kidney function (C), or reducing blood pressure (D). The primary goal of paracentesis in this context is to provide symptomatic relief by removing the accumulated fluid, thereby reducing pressure on surrounding organs and improving the client's comfort and overall well-being.
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A patient with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). What is the priority nursing action?
- A. Administer regular insulin intravenously.
- B. Give oral hypoglycemic agents.
- C. Administer sodium bicarbonate.
- D. Provide a high-calorie diet.
Correct Answer: A
Rationale: The correct answer is A: Administer regular insulin intravenously. In DKA, the priority is to lower blood glucose levels and correct acidosis. Regular insulin intravenously is the fastest way to reduce blood glucose levels. Oral hypoglycemic agents (B) are not effective in DKA. Sodium bicarbonate (C) is not routinely recommended in DKA as it may worsen acidosis. Providing a high-calorie diet (D) is not appropriate as the focus should be on treating the underlying condition first.
Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?
- A. Continue taking warfarin until the day of surgery.
- B. Stop taking warfarin three days before surgery.
- C. Switch to aspirin before surgery.
- D. Stop taking warfarin one week before surgery.
Correct Answer: D
Rationale: The correct answer is D because stopping warfarin one week before surgery reduces the risk of excessive bleeding during the procedure. Warfarin's anticoagulant effect can persist for several days, so stopping it earlier allows time for its effects to diminish. Choice A is incorrect because continuing warfarin until the day of surgery increases bleeding risk. Choice B is incorrect as stopping warfarin only three days before surgery may not provide enough time for the anticoagulant effect to wear off. Choice C is incorrect as aspirin is not a suitable substitute for warfarin in most cases.
A patient with coronary artery disease (CAD) is prescribed a statin medication. What should the nurse include in the patient education?
- A. Take the medication with food.
- B. Report any muscle pain or weakness.
- C. Increase intake of grapefruit juice.
- D. Avoid foods high in potassium.
Correct Answer: B
Rationale: Step 1: Statins can cause muscle pain or weakness as a side effect.
Step 2: Prompt reporting of muscle pain or weakness is crucial to address potential myopathy or rhabdomyolysis.
Step 3: Nurse should educate patient to report any muscle symptoms promptly for timely intervention and prevention of complications.
Summary: Option B is correct as it emphasizes the importance of monitoring and reporting potential side effects of statins. Options A, C, and D are incorrect as taking with food, increasing grapefruit juice intake, and avoiding potassium-rich foods are not relevant considerations for statin therapy.
A patient with anemia is prescribed ferrous sulfate. What advice should the nurse give regarding the administration of this medication?
- A. Take with dairy products to increase absorption.
- B. Take on an empty stomach for best absorption.
- C. Avoid vitamin C while taking this medication.
- D. Take before bedtime.
Correct Answer: B
Rationale: The correct answer is B: Take on an empty stomach for best absorption. Ferrous sulfate is best absorbed on an empty stomach to maximize its effectiveness. When taken with food or dairy products (Choice A), the absorption of iron is reduced. Vitamin C actually enhances the absorption of iron, so avoiding it (Choice C) is not recommended. Taking the medication before bedtime (Choice D) may lead to gastrointestinal side effects and is not optimal for absorption.
During an assessment, a healthcare professional suspects a client has cholecystitis. What is a common symptom of this condition?
- A. Right upper quadrant pain
- B. Left lower quadrant pain
- C. Generalized abdominal pain
- D. Epigastric pain
Correct Answer: A
Rationale: The correct answer is A: Right upper quadrant pain. Cholecystitis is inflammation of the gallbladder, typically caused by gallstones. The gallbladder is located in the right upper quadrant of the abdomen, so pain in this area is a common symptom. The pain may also radiate to the back or right shoulder. Choices B, C, and D are incorrect because they do not typically align with the specific location of the gallbladder or the characteristic pain associated with cholecystitis.