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Questions 227

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Extract:

Thirty minutes after delivery the nurse finds that a mother's uterus is relaxed and the lochia is excessive.


Question 1 of 5

The fist action by the nurse should be to:

Correct Answer: D

Rationale: Massaging the uterus promotes contraction, reducing excessive lochia and preventing hemorrhage.

Extract:

When explaining the therapeutic regimen of vitamin B12 for pernicious anemia to a patient the nurse should explain that:


Question 2 of 5

When explaining the therapeutic regimen of vitamin B12 for pernicious anemia to a patient the nurse should explain that:

Correct Answer: C

Rationale: Monthly B12 injections maintain control in pernicious anemia due to absorption deficits.

Extract:


Question 3 of 5

A client with which of the following conditions is at risk for developing a high ammonia level?

Correct Answer: D

Rationale: Cirrhosis impairs the liver's ability to metabolize ammonia, leading to elevated levels and risk of hepatic encephalopathy. The other conditions do not directly affect ammonia levels. Reduction of Risk Potential

Question 4 of 5

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's wife reports that she noticed that he acted confused and was extremely weak when he woke up in the morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101°F (38.3°C). A diagnosis of acute adrenal insufficiency is made. Which of the following would the nurse expect to administer by I.V. infusion?

Correct Answer: B

Rationale: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given 100 mg of hydrocortisone in normal saline every 6 hours until his blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal - not hypotonic - saline solution.

Question 5 of 5

The nurse is teaching a client about the healthy use of ego defense mechanisms. An appropriate goal for this client would be

Correct Answer: A

Rationale: Reduce fear and protect self-esteem. Ego defense mechanisms are unconscious proactive barriers that are used to manage instinct and affect in the presence of stressful situations. Healthy reactions are those in which the client admits that they are feeling various emotions.

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