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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. During operation, who manages the lighting, noise, temperature and other factors in the operating room suite?
- A. Nurse Supervisor
- B. Surgeon
- C. Circulating Nurse
- D. Scrub Nurse
Correct answer: C
Rationale: In an operating room, the circulating nurse is responsible for managing environmental factors such as lighting, noise, and temperature. This role includes ensuring the comfort and safety of the patient, as well as the efficiency of the team. While the Nurse Supervisor, Surgeon, and Scrub Nurse also have crucial roles during an operation, they do not directly manage the environmental conditions of the operating room. The rationale provided does not directly address the question asked, and appears to relate more to the broader role of nursing in patient care.
3. Based on the Code of Ethics for Filipino Nurses, what is regarded as the hallmark of nursing responsibility and accountability?
- A. Human rights of clients, regardless of creed and gender
- B. The privilege of being a registered professional nurses
- C. Health, being a fundamental right of every individual
- D. Accurate documentation of actions and outcomes
Correct answer: B
Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.
4. In taking the client’s blood pressure, the nurse should position the client’s arm:
- A. At the level of the heart
- B. Slightly above the level of the heart
- C. At the 5th intercostals space midclavicular line
- D. Below the level of the heart
Correct answer: A
Rationale: Proper patient positioning is essential for maximizing lung expansion and promoting the drainage of secretions. Postural drainage techniques rely on gravity to help clear different lung segments, which is critical in preventing complications such as atelectasis or pneumonia in immobilized patients.
5. What should Mrs. Smith do to increase her HDL levels, as advised by the nurse?
- A. Monitor her blood glucose levels
- B. Quit smoking
- C. Control her blood pressure
- D. Take fish oil supplements
Correct answer: B
Rationale: The correct answer is 'Quit smoking.' Smoking has been shown to lower HDL (High-Density Lipoprotein) levels, and quitting can help to improve these levels. HDL is often referred to as 'good cholesterol' because it helps to remove other forms of cholesterol from the bloodstream, reducing the risk of heart disease. While monitoring blood glucose levels, controlling blood pressure, and taking fish oil supplements can contribute to overall health and wellbeing, they do not directly increase HDL levels in the same way that quitting smoking does. Therefore, quitting smoking is the most effective way for Mrs. Smith to increase her HDL levels as advised by the nurse.
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