Isotonic solutions include:

Correct Answer: C

Rationale: The correct answer is C because isotonic solutions have a similar osmolarity to human blood, which helps maintain fluid balance without causing cell shrinkage or swelling. Normal saline 0.9% and ringers lactate are isotonic solutions commonly used in medical settings. Normal saline has a concentration of 0.9% sodium chloride, which closely matches the electrolyte composition of blood plasma. Ringers lactate contains electrolytes (sodium, potassium, calcium, and lactate) that closely mimic the body's extracellular fluid composition. Choice A (Normal saline 0.45%, dextrose 5%) is hypotonic because it has a lower osmolarity than blood, which can cause cells to swell. Choice B (Dextrose 50%, normal saline 0.45%) is hypertonic due to the high concentration of dextrose, which can draw water out of cells. Choice D (Aminosyn 3.5%, dextran

Correct Answer: C

Rationale: The correct answer is C: Clipping the hair in the area. This is the best option as it removes excess hair without the risk of causing microabrasions or skin irritation, which could increase the risk of infection. Clipping is less traumatic to the skin compared to shaving, which can cause microcuts. Leaving the hair intact can make it difficult to properly clean and maintain the site. Using a depilatory is not recommended as it can cause chemical irritation and is unnecessary for this purpose. Overall, clipping the hair in the area is the most appropriate and safe method for managing excess hair at an I.V. catheter insertion site.

Correct Answer: B

Rationale: Correct Answer: B - Kinked or obstructed chest tube. Rationale: 1. Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, causing lung collapse. 2. Signs include respiratory distress, chest pain, hypoxia, and tracheal deviation. 3. Nurse Amanda must check the chest tube for kinks or obstructions as it can prevent proper drainage and exacerbate the condition. 4. Infection of the lung (A) may be a concern but is not immediate in tension pneumothorax. 5. Excessive water in the water-seal chamber (C) may indicate a leak but is not directly related to tension pneumothorax. 6. Excessive chest tube drainage (D) may be expected initially, but if it suddenly stops, it could indicate kinking or obstruction.

Correct Answer: A

Rationale: The correct initial response is A: Explain the risks of not having the surgery. This is crucial to ensure the client fully understands the consequences of refusing the surgery. It allows the nurse to address any concerns or misconceptions the client may have, enabling an informed decision-making process. Notifying the physician immediately (B) may be necessary but should follow after attempting to provide education. Notifying the nursing supervisor (C) is not the priority in this situation. Recording the client’s refusal in the nurses’ notes (D) is important but should not be the first action taken.

Correct Answer: D

Rationale: The correct answer is D: Counselor. The nurse assumes the role of counselor when guiding a client in making healthcare decisions by providing emotional support, helping the client explore options, and facilitating informed decision-making. A leader typically involves taking charge or directing a group, which may not always be appropriate in this context. An advocate focuses on promoting the client's rights and best interests but may not necessarily provide the counseling aspect. A liaison acts as a link or intermediary between the client and other healthcare providers, which is different from providing direct counseling and support.