Physiological Safety/Nutrition

A client comes to the emergency department complaining of difficulty breathing and feeling strange after eating a shrimp cocktail. The client is leaning forward with a respiratory rate of 36 breaths per minute. The nurse suspects 1.__________. 2. What is the nurse's priority action? Fill in the blank for #1 Multiple choice for #2. 2. a) Decreasing anxiety b) Maintaining an open airway c) Providing Pain relief measures d) Encouraging activity 3. What emergency medications should the nurse anticipate to give to this patient? 4. During discharge, what should the nurse educate the patient on primary prevention?

1. Anaphylaxis 2. b) Maintaining an open airway 3. Epinephrine 1:1000, diphenhydramine( Benadryl), Glucocorticoids. 4. Avoiding the allergen, in this situation shrimp and other shellfish products. Patient should have an Epi pen and be educated on how to use it in case of exposure. Thorough history of allergy with future health care visits to avoid certain dyes or prep agents (Betadine).

During a mumps outbreak at a local school, a teacher has been exposed. The client has previously been immunized for mumps and consequently posses: a) Acquired Immunity b) Natural Immunity c) Phagocytic immunity d) Humoral immunity

a) Acquired Immunity

A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a.) Fried chicken b.) Dinner roll c.) Yogurt d.) Mac and Cheese

a.) Fried chicken

A nurse cares for a client who is post op bariatric surgery and the nurse offers the client a sugar-free beverage. What is the primary purpose of offering a sugar-free beverage? a.) These are less likely to cause dumping syndrome. b.) These are less likely to raise the blood sugar. c.) These ease nausea. d.) Ease gastric distention

a.) These are less likely to cause dumping syndrome.

The client presents to the emergency department with a suspected allergic reaction to the antibiotic they were given at the quick care clinic to treat their pneumonia. What are the priority actions the nurse should take? Select all that apply. a) Evaluate for hypertension b) Insert an intravenous line c) Administer Vitamin K d) Take vital signs e) Check for diplopia f) Apply 02 nasal cannula

b) Insert an intravenous line d) Take vital signs f) Apply 02 nasal cannula

When caring for a client with cirrhosis, which symptom(s) should the nurse report immediately? a.) Fatigue and weight loss b.) Change in mental status c.) Anorexia and dyspepsia d.) Diarrhea or constipation

b.) Change in mental status

A client has been prescribed cimetidine/Tagament for the treatment of peptic ulcer disease. When providing relevant health education for this client, the nurse should ensure the client is aware of what potential outcome? a.) Bowel incontinence b.) Drug-drug interactions c.) Abdominal pain d.) Heat intolerance

b.) Drug-drug interactions

A 35 y.o. male client came into the Health Department and asked the nurse "Do I need the Varicella Vaccine if I had chickenpox as a child?". The nurses best response would be: a). "Yes. Acquired Immunity only lasts for 2-4 years. The Varicella Vaccine is strongly recommended for adults". b). "Yes. Natural Immunity is not enough to fight off Varicella so it is strongly recommended for adults". c). "No. You have acquired immunity due to prior exposure of Chicken Pox. You have antigens built up to fight off any future exposure to Varicella" . d.) "No. Your natural immunity will fight of the Varicella virus if you become exposed".

c). "No. You have acquired immunity due to prior exposure of Chicken Pox. You have antigens built up to fight off any future exposure to Varicella" .

A nurse is caring for a client who has allergic rhinitis. What intervention would be most likely to help the client meet the goal of improved breathing pattern? a) Teach the client to take deep breaths and cough frequently. b) Use antihistamines daily throughout the year c) Teach the client to seek medical attention at the first sign of an allergic reaction d) Modify the environment to reduce the severity of allergic symptoms

d) Modify the environment to reduce the severity of allergic symptoms

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response? a.) "You could have gotten it by using I.V. drugs." b.) "You must have received an infected blood transfusion." c.) "You probably got it by engaging in unprotected sex." d.) "You may have eaten contaminated restaurant food."

d.) "You may have eaten contaminated restaurant food."

During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in: a.) Thiamine b.) Vitamin C. c.) Riboflavin d.) Vitamin K

d.) Vitamin K

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as a.) urticaria b.) contact dermatitis. c.) pitting edema d.) angioneurotic edema

d.) angioneurotic edema

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? a.) Developing no acute complications from the pancreatitis b.) Maintaining normal respiratory function c.) Maintaining satisfactory pain control d.) Achieving adequate fluid and electrolyte balance

b.) Maintaining normal respiratory function

A client with Acute Gastritis is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? a.) "Eat three balanced meals every day." b.) "Stop taking the drugs when your symptoms subside." c.) "Avoid aspirin and products that contain aspirin." d.) "Increase your intake of fluids containing caffeine."

c.) "Avoid aspirin and products that contain aspirin."

A patient is diagnosed with an autoimmune Pernicious Anemia. The patient has signs and symptoms of peripheral numbness and tingling and some mental confusion. The nurse knows the best treatment will include: a.) Oral Vitamin B12 supplements b.) Diet high in protein and dairy c.) IM or intranasal B12 d.) Sublingual or topical B12

c.) IM or intranasal B12