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1. A client with Crohn's disease is receiving parenteral nutrition. Which of the following interventions should the nurse not include in the care of this client?
- A. Remove the parenteral nutrition solution from the refrigerator 2 hours before infusion.
- B. Remove unused parenteral nutrition after 12 hours of use.
- C. Monitor daily laboratory values and report abnormalities as needed.
- D. Monitor the flow rate of the parenteral nutrition carefully and adjust it if necessary.
Correct answer: B
Rationale: In caring for a client receiving parenteral nutrition, it is important to follow proper guidelines to ensure safety and effectiveness. Unused parenteral nutrition should be removed after 24 hours, not 12 hours, to prevent contamination and reduce the risk of infection. Option A is correct as it ensures the solution is at room temperature before infusion. Option C is essential for monitoring the client's response to parenteral nutrition. Option D is important to maintain the correct flow rate and adjust it as needed. Therefore, option B is the incorrect choice among the options provided.
2. Which of the following best represents the goal of reflective listening?
- A. Repeating what the patient says
- B. Informing using direct advice
- C. Keeping the patient talking
- D. Warning the patient
Correct answer: C
Rationale: The correct answer is C. The goal of reflective listening is to keep the patient talking, allowing them to express their thoughts and concerns fully. Choice A, 'Repeating what the patient says,' is incorrect as reflective listening involves paraphrasing or summarizing rather than verbatim repetition. Choice B, 'Informing using direct advice,' is incorrect because reflective listening focuses on understanding the patient's perspective rather than providing direct advice. Choice D, 'Warning the patient,' is also incorrect as reflective listening aims to create a safe and open environment for the patient to share without feeling judged or warned.
3. Diseases of the heart and blood vessels are collectively referred to as _____.
- A. Coronary artery disease
- B. Cardiovascular disease
- C. Coronary heart disease
- D. Coronary vessel disease
Correct answer: B
Rationale: The correct term for diseases of the heart and blood vessels is cardiovascular disease. While coronary artery disease (Choice A) specifically involves the narrowing of coronary arteries, it is just one type of cardiovascular disease. Coronary heart disease (Choice C) is also a specific condition related to the heart's blood vessels. Choice D, coronary vessel disease, is not a commonly used term to describe diseases of the heart and blood vessels. Therefore, Choice B, cardiovascular disease, is the most inclusive and appropriate term to refer to these conditions.
4. What does oliguria lead to in patients with acute kidney injury?
- A. Hypophosphatemia and overgrowth of bone tissue
- B. An increase in blood potassium levels due to excessive excretion of parathyroid hormone
- C. Sodium retention and elevated levels of potassium
- D. Edema due to increased urine production
Correct answer: C
Rationale: In patients with acute kidney injury, oliguria (reduced urine output) often results in sodium retention and hyperkalemia (elevated levels of potassium). This is due to the kidneys' decreased capacity to excrete these substances. Choice A is incorrect because hypophosphatemia and overgrowth of bone tissue are not direct consequences of oliguria in acute kidney injury. Choice B is incorrect because an increase in blood potassium levels is not caused by excessive excretion of parathyroid hormone but rather by decreased excretion of potassium. Choice D is incorrect because edema is not caused by increased urine production but rather by fluid overload due to decreased urine output.
5. A multivitamin supplement containing folic acid is recommended for all young women because of the number of unintentional pregnancies in women 15 to 24 years old.
- A. Both the statement and the reason are correct and related
- B. Both the statement and the reason are correct but are not related
- C. The statement is correct, but the reason is not correct
- D. The statement is not correct, but the reason is correct
Correct answer: A
Rationale: Both the statement and the reason are correct and related. A multivitamin with folic acid is recommended for young women due to the high incidence of unplanned pregnancies in this age group.
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