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Questions 158

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Extract:


Question 1 of 5

The nurse is caring for a client with a history of a diabetic foot ulcer. The nurse should:

Correct Answer: B

Rationale: Elevating the foot reduces swelling and promotes healing in a diabetic foot ulcer. Heating pads, soaking, and massage increase infection risk or impair circulation.

Question 2 of 5

The physician has ordered an injection of RhoGAM (Rho[D] immune globulin) for the postpartum client whose blood type is A negative and whose baby is O positive. To provide postpartum prophylaxis,RhoGAM should be administered:

Correct Answer: A

Rationale: RhoGAM prevents Rh sensitization in Rh-negative mothers by neutralizing fetal Rh-positive blood cells. It must be administered within 72 hours of delivery for effective prophylaxis.

Question 3 of 5

A client with a history of a burn injury is being discharged. The nurse should teach the client to:

Correct Answer: A

Rationale: Avoiding sun exposure protects healing burn skin from UV damage and hyperpigmentation. Harsh soaps, petroleum lotions, and tight clothing can irritate or delay healing.

Question 4 of 5

A 52-year-old female client is admitted to the hospital in acute renal failure. She has been on hemodialysis for the past 2 years. Stat arterial blood gases are drawn on the client yielding the following results: pH 7.30, PCO2 51 mm Hg, HCO3 18 mEq/L, PaO2 84 mm Hg. The nurse would interpret these results as:

Correct Answer: D

Rationale: Compensated metabolic alkalosis would be reflected by the following: pH within normal limit (7.35-7.45), PCO2 >45 mm Hg, HCO3 >26 mEq/L. Respiratory acidosis would be reflected by the following: pH <7.35, PCO2 >45 mm Hg, HCO3 within normal limits (22-26 mEq/L). Partially compensated metabolic alkalosis would be reflected by the following: pH >7.45, PCO2 >45 mm Hg, HCO3 >26 mEq/L. Combined respiratory and metabolic acidosis would be reflected by the following: pH <7.35, PCO2 >45 mm Hg, HCO3 <22 mEq/L.

Question 5 of 5

The nurse working in the emergency department realizes that it would be contraindicated to induce vomiting if someone had ingested which of the following?

Correct Answer: D

Rationale: Inducing vomiting after gasoline ingestion is contraindicated due to aspiration risk, which can cause pneumonitis. Ibuprofen (
A), aspirin (
B), and vitamins (
C) are safer to induce vomiting for, if needed.

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