Correct Answer: C

Rationale:
Correct Answer: C. Increase water intake and use bulk-forming laxatives.


Rationale: Increasing water intake helps soften stool, easing constipation in IBS-C. Bulk-forming laxatives add fiber to stool, improving bowel movements. Stimulant laxatives (
A) can lead to dependency. Avoiding fiber-rich foods (
B) worsens constipation. A low-carbohydrate diet (
D) may exacerbate constipation.

Correct Answer: A

Rationale: The correct answer is A: Retention of carbon dioxide. In respiratory acidosis, there is an accumulation of carbon dioxide in the bloodstream due to inadequate ventilation. This leads to increased levels of carbonic acid, causing the blood pH to decrease. The nurse should identify this mechanism as responsible for the acid-base imbalance.
Loss of bicarbonate (
B) would lead to metabolic acidosis, not respiratory acidosis. Excessive vomiting (
C) would result in metabolic alkalosis. Hyperventilation (
D) would actually help correct respiratory acidosis by blowing off excess carbon dioxide.

Correct Answer: D

Rationale: The correct answer is D. Tachypnea, productive cough with yellow mucus in a client with COPD indicate a potential exacerbation requiring immediate follow-up. Tachypnea suggests respiratory distress, while yellow mucus may indicate infection. Prompt intervention can prevent worsening respiratory status.

Choices A, B, and C do not indicate acute respiratory distress. Option E may be concerning but doesn't necessitate immediate intervention like option D does.

Correct Answer: D

Rationale: The correct action to take first when caring for a client experiencing a seizure is to clear items from the client's surrounding area (
Choice
D). This is important to prevent injury to the client during the seizure. By removing objects that could cause harm, such as sharp or hard items, the nurse ensures a safe environment for the client. Lowering the client to the floor (
Choice
A) is important but should be done after clearing the surroundings to prevent injury. Obtaining vital signs (
Choice
B) and loosening restrictive clothing (
Choice
C) can be done after ensuring the safety of the environment. Thus, the priority is to clear items from the client's surrounding area to prevent harm during the seizure.

Correct Answer: A,B,C,D

Rationale: [
Anticipated: Request a prescription for insulin, Request for an antibiotic to be administered, Decrease the client's oxygen to 1.5 L/min via nasal cannula, Have 3 nurses verify the TPN solution prescription.

Rationale: A client on TPN may require insulin for glycemic control, antibiotics for infection management, oxygen adjustment for respiratory support, and verification of TPN solution to prevent errors.
Non-essential/Contraindicated: Not applicable as all options are essential in the care of a client receiving TPN.]