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NEW QUESTION 46
The nurse is preparing a 6-year-old child for an IV insertion. Which one of the following statements by the nurse is appropriate when preparing a child for a potentially painful procedure?
- A. "This is going to hurt a lot; close your eyes and hold my hand."
- B. "Some say this feels like a pinch or a bug bite. You tell me what it feels like."
- C. "This is a terrible procedure, so don't look."
- D. "This will hurt only a little; try to be a big boy."
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Educating the child about the pain may lessen anxiety. The child should be prepared for a potentially painful procedure but avoid suggesting pain. The nurse should allow the child his own sensory perception and evaluation of the procedure. (B) The nurse should avoid absolute descriptive statements and allow the child his own perception of the procedure. (C) The nurse should avoid evaluative statements or descriptions and give the child control in describing his reactions. (D) False statements regarding a painful procedure will cause a loss of trust between the child and the nurse.
NEW QUESTION 47
A pregnant client complains of varicosities in the third trimester. Which of the following activities should she be advised to avoid?
- A. Wearing thromboembolic disease (TED) stockings
- B. Sitting with legs crossed at ankles
- C. Wearing knee-high stockings
- D. Wearing support pantyhose
Answer: C
Explanation:
Section: Questions Set F
Explanation:
(A) Sitting with the legs crossed at the ankles does not interfere with circulation or create pressure points. (B) TED stockings will help to reduce the varicosity by supporting the vein. Stockings must be applied with legs elevated. (C) Support pantyhose help to reduce the varicosity by supporting the vein. They also provide support to the uterus and allow for better return circulation. Hose must be applied like TED stockings. (D) Knee-high stockings create constriction and pressure points that interfere with circulation in the lower extremities.
NEW QUESTION 48
The mother of a client is apprehensive about taking home her 2 year old who was diagnosed with asthma after being admitted to the emergency room with difficulty breathing and cyanosis. She asks the nurse what symptoms she should look for so that this problem will not happen again. The nurse instructs her to watch for the following early symptoms:
- A. Changes in breathing pattern, moodiness, fatigue, and edema of eyes
- B. Fatigue, dark circles under the eyes, changes in breathing pattern, glassy eyes, and moodiness
- C. Fever, cough, paleness, and wheezing
- D. Fever, runny nose, and hyperactivity
Answer: B
Explanation:
Explanation
(A) The child with asthma may not have fever unless there is an underlying infection. (B) Edema of the eyes will not be present because the child with asthma is more likely to have dehydration related to excessive water loss during the work of breathing. (C) All of these symptoms indicate decreased oxygenation and are early symptoms of asthma. (D) Coughing and wheezing are not early signs of difficulty.
NEW QUESTION 49
Which of the following would indicate the need for further teaching for the client with COPD? The client verbalizes the need to:
- A. Take vitamin supplementation
- B. Eat high-calorie, high-protein foods
- C. Eliminate intake of milk and milk products
- D. Eat small, frequent meals
Answer: C
Explanation:
(A) Protein is vital for the maintenance of muscle to aid in breathing. A high-calorie diet using higher fat than carbohydrate content is given because clients are unable to breathe off the excess CO2that is an end product of carbohydrate metabolism. (B) Inadequate nutritional status, in particular, deficiencies in vitamins A and C, decreases resistance to infection. (C) Milk does not make mucus thicker. It may coat the back of the throat and make it feel thicker. Rinsing the mouth with water after drinking milk will prevent this problem. (D) Small, frequent meals minimize a fullness sensation and reduce pressure on the diaphragm. The work of breathing and SOB are also reduced.
NEW QUESTION 50
A client's record from the ED indicates that she overdosed on phenelzine sulfate (Nardil), a monoamine oxidase (MAO) inhibitor. Which diet would be the most appropriate at this time?
- A. Tyramine-free
- B. 1 g sodium
- C. High carbohydrate, low cholesterol
- D. High protein, high carbohydrate
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) There are no data to support the need for increased carbohydrates or decreased cholesterol in the diet.
(B) There is no data to support the need for increased protein or increased carbohydrates in the diet. (C) There is no assessment or laboratory data indicating that sodium should be restricted in the diet. (D) Tyramine is an amino acid activated by MAO in the liver and intestinal wall. It is released as proteins are hydrolyzed through aging, pickling, smoking, or spoilage of foods. When MAO is inhibited, tyramine levels rise, stimulating the adrenergic system to release large amounts of norepinephrine, which can produce a hypertensive crisis.
NEW QUESTION 51
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