Nokea
Why is a pulse oximeter attached to Mr. Dizon's finger?
- A. To determine if the patient's hemoglobin level is low and if he requires a blood transfusion
- B. To check the level of the patient's tissue perfusion
- C. To measure the effectiveness of the patient's anti-hypertensive medications
- D. To detect oxygen saturation of arterial blood before symptoms of hypoxemia develop
Correct Answer: D
Rationale: A pulse oximeter is used to detect the oxygen saturation levels in arterial blood before the onset of hypoxemia symptoms. This device provides essential information about the effectiveness of oxygen transportation to the body's tissues. Choice A is incorrect because a pulse oximeter does not directly measure hemoglobin levels nor determine the need for a blood transfusion. Choice B is incorrect because a pulse oximeter is designed specifically to assess oxygen saturation, not tissue perfusion. Choice C is incorrect because a pulse oximeter is not used to measure the efficacy of anti-hypertensive medications, but rather to monitor oxygen levels in the blood.
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Which food is a reliable source of B12 for a pregnant vegan client?
- A. Soybeans
- B. Algae
- C. Fortified soy milk
- D. Sea vegetables
Correct Answer: C
Rationale: Fortified soy milk is a reliable source of vitamin B12 for pregnant vegan clients as it is usually enriched with this vitamin. The other options, while nutritious, are not reliable sources of B12 for vegans. Soybeans may not provide enough B12, algae contains B12 analogs that the human body cannot utilize, and the B12 content in sea vegetables can fluctuate, potentially not providing the necessary daily intake.
How is an ear infection that persists for less than 14 days classified?
- A. Mastoiditis
- B. Chronic Ear Infection
- C. Acute Ear Infection
- D. Otitis Media
Correct Answer: C
Rationale: Acute Ear Infection is the correct answer because it typically refers to an infection that is short-lived and often severe, typically lasting less than 14 days. Chronic Ear Infection (Choice B) is incorrect as it refers to an ear infection that lasts for a long time or recurs often, typically more than three months. Mastoiditis (Choice A) is a complication of a middle ear infection and not an ear infection itself. Otitis Media (Choice D) is a general term for inflammation or infection in the middle ear, which can be either acute or chronic, so it's not specific enough to be the correct answer. Understanding the duration and severity of symptoms can help in identifying the type of ear infection, facilitating appropriate treatment and prevention of complications.
Which of the following is a normal change observed in an elderly individual?
- A. Enhanced sense of taste
- B. Increased appetite
- C. Frequent urination
- D. Lens thinning
Correct Answer: C
Rationale: The correct answer is C, frequent urination. As people age, they may experience physiological changes that can lead to an increased frequency of urination. This is due to a decrease in bladder capacity and increased bladder irritability, which are normal age-related changes. On the contrary, the sense of taste (Choice A) and appetite (Choice B) often decrease with age, not increase. As for Choice D, the lens of the eye actually thickens with age, not thins, leading to conditions like presbyopia. Therefore, Choices A, B, and D are incorrect.
During blood administration, what is essential for the nurse to do in order to carefully monitor for adverse reactions?
- A. Stay with the client for the first 15 minutes of blood administration
- B. Stay with the client for the entire period of blood administration
- C. Run the infusion at a faster rate during the first 15 minutes
- D. Inform the client to notify the staff immediately for any adverse reaction
Correct Answer: A
Rationale: In the context of blood administration, it's crucial for the nurse to stay with the client for the first 15 minutes. This is because most adverse reactions are likely to occur within this initial period. Monitoring the client closely during this time allows for immediate detection and response to any potential reactions. Choice B, staying with the client for the entire period of blood administration, is not typically feasible or necessary, although regular checks should be conducted. Running the infusion at a faster rate during the first 15 minutes (Choice C) is incorrect as this can actually increase the risk of adverse reactions. Informing the client to notify the staff immediately for any adverse reaction (Choice D) is an important practice, but it is not the most direct way for the nurse to monitor for adverse reactions.
When taking a blood pressure reading, where should the cuff be positioned?
- A. The cuff should be deflated fully before immediately starting a second reading for the same patient
- B. The cuff should be deflated quickly after being inflated to 180 mmHg
- C. The cuff should be large enough to wrap around the upper arm of the adult patient, positioned 1 cm above the brachial artery
- D. The cuff should be inflated to 30 mmHg above the estimated systolic BP based on palpation of the radial or brachial artery
Correct Answer: D
Rationale: When measuring blood pressure, the cuff should be inflated to 30 mmHg above the estimated systolic blood pressure based on palpation of the radial or brachial artery. This ensures an accurate blood pressure measurement. Choices A, B, and C are incorrect. Deflating the cuff fully before starting a second reading (Choice A) does not directly relate to the position of the cuff during a reading. Deflating the cuff quickly after inflating to 180 mmHg (Choice B) is not recommended because it can potentially lead to inaccurate readings. While ensuring the cuff is large enough to wrap around the upper arm positioned 1 cm above the brachial artery is important (Choice C), this alone does not guarantee an accurate blood pressure reading. The correct inflation based on palpation is the key element for accuracy, which is why Choice D is correct.