Correct Answer: C

Rationale: Ensuring that the nasogastric tube is functioning is the most important nursing action when caring for a patient with a paralytic ileus. A paralytic ileus is a condition where there is a temporary paralysis of the intestine, leading to a lack of bowel motility. This can result in a buildup of gas and fluids in the intestines, causing abdominal distension, pain, and potential complications.

Correct Answer: C

Rationale: In a client experiencing hypovolemic shock, the priority collaborative intervention is to provide replacement of volume to improve tissue perfusion and restore organ function. Hypovolemic shock is characterized by a significant loss of intravascular volume, leading to inadequate tissue perfusion and oxygenation. Beta-adrenergic blockers can exacerbate hypovolemic shock by further decreasing cardiac output and blood pressure. Therefore, the immediate priority is to address the hypovolemia by providing volume replacement through fluid resuscitation to stabilize the patient before assessing the cause of bleeding or establishing invasive cardiac monitoring. Administering analgesics for pain control is important but not the priority in this situation.

Correct Answer: C

Rationale: A urine output of 200 mL in 8 hours is considered low, especially for a client with cardiomyopathy who is receiving diuretic therapy. This could indicate inadequate cardiac output or worsening heart failure. It is crucial for the nurse to notify the healthcare provider promptly so that appropriate interventions can be initiated to address the underlying cause and prevent further complications. Waiting for improvement without taking action could lead to deterioration in the client's condition.

Correct Answer: D

Rationale: Terazosin is an alpha-1 adrenergic receptor blocker. By blocking alpha-1 receptors in the vascular smooth muscle, terazosin causes dilation of both arteries and veins, leading to reduced peripheral vascular resistance and decreased blood pressure. This dilation effect is achieved by preventing the binding of norepinephrine to alpha-1 receptors, thereby inhibiting vasoconstriction. Terazosin is commonly used in the treatment of hypertension to help lower blood pressure by reducing the workload on the heart and improving blood flow to organs and tissues.

Correct Answer: D

Rationale: Crepitation refers to a grating sound or sensation that occurs when there is rubbing together of the roughened articular surfaces of bones within a joint. It is commonly associated with conditions such as osteoarthritis or joint injury. Therefore, if the nurse hears a grating sound while assessing the range of motion of a patient's hip, the appropriate documentation of this finding would be crepitation.