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1. A client with stomatitis is receiving teaching from a nurse. Which of the following client statements indicates a need for further teaching?
- A. "I will drink liquids through a straw."?
- B. "I will season foods with dried spices before cooking."?
- C. "I will rinse my mouth with baking soda and water frequently."?
- D. "I will eat frozen bananas as a snack."?
Correct answer: C
Rationale: The correct answer is, "I will rinse my mouth with baking soda and water frequently."? Stomatitis is an inflammation of the mucous lining in the mouth, and rinsing with baking soda and water can be too abrasive and further irritate the condition. Choices A, B, and D are appropriate self-care measures for a client with stomatitis and do not indicate a need for further teaching.
2. Which of the following is a tricyclic antidepressant drug?
- A. Venlafaxine (Effexor)
- B. Fluoxetine (Prozac)
- C. Sertraline (Zoloft)
- D. Imipramine (Tofranil)
Correct answer: D
Rationale: Imipramine (Tofranil) is a tricyclic antidepressant drug. This class of medications is used to treat depression, and they work by increasing the levels of certain chemicals in the brain that help lift mood. On the other hand, Venlafaxine (Effexor) is a serotonin and norepinephrine reuptake inhibitor (SNRI), Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI), and Sertraline (Zoloft) is also an SSRI. Therefore, they are not classified as tricyclic antidepressants.
3. Which of the following has the greatest effect on an increase in body weight?
- A. Carbohydrate intake
- B. Protein intake
- C. Fat intake
- D. Total kilocalories
Correct answer: D
Rationale: Total kilocalories have the greatest effect on body weight as they represent the overall energy intake from all macronutrients combined. While the consumption of specific macronutrients like carbohydrates, proteins, and fats can affect weight management, the total calories consumed play the most significant role in determining body weight. Therefore, choices A, B, and C are incorrect as they focus on individual macronutrients rather than the overall energy balance provided by total kilocalories.
4. 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.
5. A nurse is preparing to administer a gavage feeding via a nasogastric tube to a preterm newborn who is receiving supplemental oxygen. Which of the following actions should the nurse take?
- A. Stabilize the tube with tape to the newborn’s cheek.
- B. Remove supplemental oxygen during the feeding.
- C. Measure the stomach aspirate prior to the feeding.
- D. Place the newborn on their left side for 30 minutes after the feeding.
Correct answer: C
Rationale: Measuring the stomach aspirate prior to the feeding is crucial to ensure the correct placement and function of the nasogastric tube. This step helps prevent complications such as aspiration or improper feeding. Choice A is incorrect as stabilizing the tube with tape to the newborn’s cheek can cause discomfort and skin irritation. Choice B is incorrect because removing supplemental oxygen during the feeding may compromise the newborn's respiratory status. Choice D is incorrect because placing the newborn on their left side for 30 minutes after the feeding is not a standard practice and is unnecessary for administering gavage feeding.
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