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Questions 158

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Question 1 of 5

The most important reason to closely assess circumferential burns at least every hour is that they may result in:

Correct Answer: D

Rationale: Full-thickness circumferential burns are nonelastic and create an internal tourniquet effect, compromising distal blood flow in extremities or respiratory motion in the torso, leading to loss of peripheral pulses.

Question 2 of 5

After the RN is finished the initial assessment of a newborn baby and after the initial bonding between the newborn and the mother has taken place in the delivery room, the RN will bring the newborn to the well-baby nursery. Before the newborn is taken from the delivery room and brought to the well-baby nursery, the RN makes sure that which of the following interventions was completed?

Correct Answer: D

Rationale: Tagging the mother and infant with identical bands ensures proper identification, preventing mix-ups and ensuring safety.

Question 3 of 5

A client with a renal failure is prescribed a low potassium diet. Which food choice would be best for this client?

Correct Answer: D

Rationale: A low potassium diet is essential for clients with renal failure to prevent hyperkalemia. Among the options, 1 cup of rice has the lowest potassium content (approximately 50–100 mg per cup), making it the best choice. Beef broth contains moderate potassium (around 200 mg per cup), a baked potato with skin is high in potassium (about 900 mg), and raisins are also high (around 500 mg per half cup).

Question 4 of 5

A 67-year-old postoperative TURP client has hematuria. The nurse caring for him reviews his postoperative orders and recognizes that which one of the following prescribed medications would best relieve this problem?

Correct Answer: D

Rationale: Acetaminophen (Tylenol) has analgesic and antipyretic actions approximately equivalent to those of aspirin. It produces analgesia possibly by action on the peripheral nervous system. It reduces fever by direct action on the hypothalamus heat-regulating center with consequent peripheral vasodilation. It is generally used for temporary relief of mild to moderate pain, such as a simple headache, minor joint and muscle pains, and control of fever. Meperidine is a narcotic agonist analgesic with properties similar to morphine except that it has a shorter duration of action and produces less depression of urinary retention and smooth muscle spasm. It is used for moderate to severe pain, for a preoperative medication, for support of anesthesia, and for obstetrical analgesia. In a postoperative TURP client, it would be used in conjunction with other medications for relief of moderate to severe pain, but not specifically for bladder spasms associated with TURP surgery. Promethazine hydrochloride is an antihistamine, antiemetic preparation. It exerts antiserotonin, anticholinergic, and local anesthetic actions. It is used for symptomatic relief of various allergic conditions, motion sickness, nausea, and vomiting. It is used for preoperative, postoperative, and obstetrical sedation and as an adjunct to analgesics for control of pain. This answer is correct because aminocaproic acid is prescribed specifically for hematuria. Aminocaproic acid is excreted in the urine. The nurse should be alert for possible signs of thrombosis, particularly in the extremities.

Question 5 of 5

The nurse is planning care for the patient with celiac disease. In teaching about the diet, the nurse should instruct the patient to avoid which of the following for breakfast?

Correct Answer: A

Rationale: Celiac disease requires a gluten-free diet. Puffed wheat contains gluten and should be avoided. Bananas, puffed rice, and cornflakes (if certified gluten-free) are typically safe.

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