Correct Answer: A

Rationale: The correct answer is A: objective. Objective data refers to measurable and observable information obtained through physical examination or diagnostic tests. In this case, the nurse's documentation of the patient's respirations and pulse rate are objective data as they can be quantified and verified by any healthcare professional. This data is not influenced by personal feelings or interpretations, making it objective. Choice B, reflective, is incorrect as it does not describe the nature of the data provided. Choice C, subjective, is also incorrect because subjective data is based on the patient's feelings or perceptions, which is not the case here. Choice D, introspective, is incorrect as it refers to internal self-reflection, not the nature of the data being documented.

Correct Answer: A

Rationale: The correct answer is A: Administer oxygen. The first priority in caring for a client experiencing a stroke is to ensure adequate oxygen supply to the brain, as lack of oxygen can lead to further brain damage. Administering oxygen helps improve oxygenation and can prevent complications. Administering morphine (B) is not recommended as it can mask symptoms and delay diagnosis. Administering IV fluids (C) may be necessary but is not the first priority. Administering fibrinolytics (D) is a time-sensitive intervention for ischemic stroke but should be done after proper evaluation and confirmation of the type of stroke.

Correct Answer: C

Rationale: The correct answer is C: Administer aspirin. Aspirin should be administered first to prevent further clot formation and reduce the risk of recurrent stroke. Monitoring blood pressure (A) is important but not the first priority. Administering IV fluids (B) is not necessary unless indicated. Applying a warm compress (D) is not a priority in the acute management of a stroke. Administering aspirin promptly can significantly impact the client's outcome by preventing further clot formation.

Correct Answer: B

Rationale: Step 1: Increasing potassium intake helps lower blood pressure by counteracting the effects of sodium. Step 2: Potassium helps relax blood vessel walls, reducing blood pressure. Step 3: Adequate potassium intake also helps the body balance fluids and maintain normal blood pressure. Summary: A - Increasing sodium intake is counterproductive for hypertension. C - Limiting caffeine helps, but not as directly as increasing potassium. D - Fruits and vegetables are important for a heart-healthy diet and should not be reduced.

Correct Answer: A

Rationale: The correct answer is A: Administer epinephrine. Epinephrine is the first-line treatment for anaphylaxis as it quickly reverses severe allergic reactions. It works by constricting blood vessels, relaxing airway muscles, and increasing heart rate. These actions help to counteract the potentially life-threatening symptoms of anaphylaxis, such as difficulty breathing and a drop in blood pressure. Applying antihistamines (B) may help with mild allergic reactions but are not sufficient for anaphylaxis. Administering morphine (C) or pain relief (D) is not appropriate initially as they do not address the immediate life-threatening nature of anaphylaxis.