Correct Answer: B

Rationale: Moving the legs independently before turning can strain the spine and disrupt the surgical site. It does not ensure spinal alignment, which is critical after a laminectomy and discectomy to promote healing and prevent complications. Placing a pillow between the legs and turning the body as a unit maintains spinal alignment, reducing stress on the surgical site. This technique, known as logrolling, ensures the spine remains stable during movement. Turning the head and shoulders first, followed by the hips, legs, and feet, can result in twisting of the spine, which could compromise the surgical site and delay healing. It is not recommended. Using side rails for movement requires significant upper body strength and may cause twisting of the spine, which is contraindicated post-spinal surgery. This method poses a risk of disrupting the surgical repair.

Correct Answer: D

Rationale: Lispro (Humalog) is a rapid-acting insulin used for mealtime glucose control. It has an onset of 15 minutes and peaks within 30 minutes to 1 hour, making it unsuitable for basal dosing. Aspart (NovoLog), another rapid-acting insulin, is similar to lispro in its onset and peak times. It is also used for mealtime glucose control, not basal glucose regulation. Regular insulin (Humulin R) is a short-acting insulin with an onset of 30 minutes to 1 hour and a peak of 2 to 4 hours. It cannot provide the steady basal glucose control required for 24-hour coverage. Glargine (Lantus) is a long-acting insulin that provides consistent basal glucose control with no pronounced peak. It is designed for once-daily dosing to maintain stable glucose levels over 24 hours, meeting the requirements for basal dosing.

Correct Answer: D

Rationale: Chewing gum can increase salivary production, and while saliva may neutralize some stomach acid, the act of chewing can stimulate swallowing and possibly exacerbate symptoms by introducing excess air into the stomach. For GERD patients, avoiding gum may help reduce bloating and gas discomfort. Elevating the head of the bed reduces the likelihood of acid reflux during sleep by using gravity to prevent stomach contents from flowing backward into the esophagus. This strategy aligns with GERD management guidelines and reduces nighttime symptoms. Taking antacids between meals and at bedtime helps neutralize stomach acid temporarily, providing short-term relief of GERD symptoms. While effective, long-term use without addressing dietary and lifestyle factors is not ideal for managing GERD. Eating small meals is beneficial for GERD, as it prevents overdistension of the stomach, but having a bedtime snack contradicts GERD management principles. Late-night eating may increase the risk of acid reflux when lying down, thus requiring more teaching.

Correct Answer: A,B,C

Rationale: Blood pressure of 85/55 indicates hypotension, which can compromise perfusion to vital organs such as the brain and kidneys. Immediate assessment is necessary to determine the underlying cause, such as dehydration or internal bleeding. Hemoglobin level of 7 g/dL is critically low, falling below the normal range of 12–16 g/dL for women or 13–18 g/dL for men. This reflects severe anemia, which may require urgent intervention, including blood transfusion or addressing the cause of anemia. Massive bleeding from the right lower leg is an emergency due to the risk of hypovolemic shock and significant blood loss. Stabilization of the bleeding site and monitoring for signs of systemic impact is required immediately. A temperature of 96.5°F (35.8°
C) may signal mild hypothermia or a systemic condition. While it requires follow-up, it is not as immediately life-threatening as the other findings and therefore does not warrant immediate prioritization.

Correct Answer: C

Rationale: Applying a warm pack is inappropriate for controlling active bleeding, as it can exacerbate blood flow to the site, worsening the hemorrhage rather than controlling it effectively. Using a tourniquet above the bleeding site is a last-resort method typically reserved for life-threatening bleeding. It may cause complications such as nerve damage or ischemia, so other measures are prioritized first. Direct pressure or sterile pressure dressing with elevation minimizes blood loss effectively by compressing the damaged vessels, promoting clot formation, and utilizing gravity to reduce the pressure at the wound site. It is the recommended first-line method. Placing an ice pack on the bleeding site may reduce localized blood flow by inducing vasoconstriction but is less effective than direct pressure for stopping active hemorrhage. It is secondary to other control measures.