The nurse is caring for a patient with liver disease and recognizes the need to prevent
bleeding resulting from altered clotting factors and rupture of varices. Which of the
following nursing interventions would be appropriate to achieve this outcome?
(Select all that apply.)
a. Use smallest gauge possible when giving injections or drawing blood.
b. Teach the patient to avoid straining at stool, vigorous blowing of nose, and
coughing. Correct
c. Advise the patient to use soft-bristle toothbrush and avoid ingestion of irritating
food.
d. Apply gentle pressure for the shortest possible time period after performing
venipuncture.
e. Instruct the patient to avoid aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs) to prevent hemorrhage when varices are present.
Give this one a try later!
, a. Use smallest gauge possible when giving injections or drawing blood.
b. Teach the patient to avoid straining at stool, vigorous blowing of nose,
and coughing. Correct
c. Advise the patient to use soft-bristle toothbrush and avoid ingestion of
irritating food.
e. Instruct the patient to avoid aspirin and nonsteroidal anti-inflammatory
drugs (NSAIDs) to prevent hemorrhage when varices are present.
Using the smallest gauge for injections will minimize the risk of bleeding
into the tissues. Avoiding straining, nose blowing, and coughing will reduce
the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush
and avoidance of irritating food will reduce injury to highly vascular
mucous membranes. The nurse should apply gentle but prolonged
pressure to venipuncture sites to minimize the risk of bleeding.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin will increase the
risk of bleeding as an adverse effect.
A client with a stroke has dysphagia. Before allowing the client to eat, which of the
following actions should the nurse take first?
a. check the client's gag reflex
b. request a soft diet with no liquids
c. place the client in high-Fowler's position
d. test the client's ability to swallow with a small amount of water
Give this one a try later!
a. check the client's gag reflex
A postoperative patient asks the nurse why the physician ordered daily administration
of enoxaparin. Which of the following responses by the nurse is best?
a. "This medication will help prevent breathing problems after surgery, such as
pneumonia."
b. "This medication will help lower your blood pressure to a safer level, which is very
important after surgery."
,c. "This medication will help prevent blood clots from forming in your legs until your
level of activity, such as walking, returns to normal."
d. "This medication is a narcotic pain medication that will help take away any muscle
aches caused by positioning on the operating room table."
Give this one a try later!
c. "This medication will help prevent blood clots from forming in your legs
until your level of activity, such as walking, returns to normal."
Enoxaparin (Lovenox) is an anticoagulant used to prevent deep vein
thromboses (DVTs) postoperatively. All other explanations or choices do
not describe the action or purpose of enoxaparin.
For which of the following antilipemic medications would the nurse question an order
in a patient with cirrhosis of the liver?
a. niacin
b. ezetimibe
c. gemfibrozil
d. atorvastatin
Give this one a try later!
d. atorvastatin
Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage
and myopathy. Liver enzymes must be monitored frequently and the
medication stopped if these enzymes increase. Thus, liver disease is a
contraindication for atorvastatin.
Which of the following nursing diagnoses is likely to be a priority in the care of a
patient with myasthenia gravis (MG)?
a. Acute confusion
b. Bowel incontinence
, c. Activity intolerance
d. Disturbed sleep pattern
Give this one a try later!
c. Activity intolerance
The primary feature of myasthenia gravis (MG) is fluctuating weakness of
skeletal muscle. Bowel incontinence and confusion are unlikely signs of
MG, and although sleep disturbance is likely, activity intolerance is usually
of primary concern.
Which of the following instructions is most appropriate for a patient using contact
lenses who has been diagnosed with bacterial conjunctivitis?
a. Discard all opened or used lens care products and cosmetics.
b. Disinfect contact lenses by soaking in a cleaning solution for 48 hours.
c. Put all used cosmetics in a plastic bag for 1 week to kill any bacteria before reusing.
d. Disinfect all lens care products with the prescribed antibiotics drops for 1 week
after infection.
Give this one a try later!
a. Discard all opened or used lens care products and cosmetics.
The patient who wears contact lenses and develops infections should
discard all opened or used lens care products and cosmetics to decrease
the risk of reinfection from contaminated products.
The nurse recently admitted a patient with a diagnosis of Parkinson's disease (PD) to a
long-term care facility. Which of the following actions should the health care team
take in order to promote adequate nutrition for this patient?
a. Provide multivitamins with each meal.
b. Provide a diet that is low in complex carbohydrates and high in protein.
c. Provide small, frequent meals throughout the day that are easy to chew and
bleeding resulting from altered clotting factors and rupture of varices. Which of the
following nursing interventions would be appropriate to achieve this outcome?
(Select all that apply.)
a. Use smallest gauge possible when giving injections or drawing blood.
b. Teach the patient to avoid straining at stool, vigorous blowing of nose, and
coughing. Correct
c. Advise the patient to use soft-bristle toothbrush and avoid ingestion of irritating
food.
d. Apply gentle pressure for the shortest possible time period after performing
venipuncture.
e. Instruct the patient to avoid aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs) to prevent hemorrhage when varices are present.
Give this one a try later!
, a. Use smallest gauge possible when giving injections or drawing blood.
b. Teach the patient to avoid straining at stool, vigorous blowing of nose,
and coughing. Correct
c. Advise the patient to use soft-bristle toothbrush and avoid ingestion of
irritating food.
e. Instruct the patient to avoid aspirin and nonsteroidal anti-inflammatory
drugs (NSAIDs) to prevent hemorrhage when varices are present.
Using the smallest gauge for injections will minimize the risk of bleeding
into the tissues. Avoiding straining, nose blowing, and coughing will reduce
the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush
and avoidance of irritating food will reduce injury to highly vascular
mucous membranes. The nurse should apply gentle but prolonged
pressure to venipuncture sites to minimize the risk of bleeding.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin will increase the
risk of bleeding as an adverse effect.
A client with a stroke has dysphagia. Before allowing the client to eat, which of the
following actions should the nurse take first?
a. check the client's gag reflex
b. request a soft diet with no liquids
c. place the client in high-Fowler's position
d. test the client's ability to swallow with a small amount of water
Give this one a try later!
a. check the client's gag reflex
A postoperative patient asks the nurse why the physician ordered daily administration
of enoxaparin. Which of the following responses by the nurse is best?
a. "This medication will help prevent breathing problems after surgery, such as
pneumonia."
b. "This medication will help lower your blood pressure to a safer level, which is very
important after surgery."
,c. "This medication will help prevent blood clots from forming in your legs until your
level of activity, such as walking, returns to normal."
d. "This medication is a narcotic pain medication that will help take away any muscle
aches caused by positioning on the operating room table."
Give this one a try later!
c. "This medication will help prevent blood clots from forming in your legs
until your level of activity, such as walking, returns to normal."
Enoxaparin (Lovenox) is an anticoagulant used to prevent deep vein
thromboses (DVTs) postoperatively. All other explanations or choices do
not describe the action or purpose of enoxaparin.
For which of the following antilipemic medications would the nurse question an order
in a patient with cirrhosis of the liver?
a. niacin
b. ezetimibe
c. gemfibrozil
d. atorvastatin
Give this one a try later!
d. atorvastatin
Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage
and myopathy. Liver enzymes must be monitored frequently and the
medication stopped if these enzymes increase. Thus, liver disease is a
contraindication for atorvastatin.
Which of the following nursing diagnoses is likely to be a priority in the care of a
patient with myasthenia gravis (MG)?
a. Acute confusion
b. Bowel incontinence
, c. Activity intolerance
d. Disturbed sleep pattern
Give this one a try later!
c. Activity intolerance
The primary feature of myasthenia gravis (MG) is fluctuating weakness of
skeletal muscle. Bowel incontinence and confusion are unlikely signs of
MG, and although sleep disturbance is likely, activity intolerance is usually
of primary concern.
Which of the following instructions is most appropriate for a patient using contact
lenses who has been diagnosed with bacterial conjunctivitis?
a. Discard all opened or used lens care products and cosmetics.
b. Disinfect contact lenses by soaking in a cleaning solution for 48 hours.
c. Put all used cosmetics in a plastic bag for 1 week to kill any bacteria before reusing.
d. Disinfect all lens care products with the prescribed antibiotics drops for 1 week
after infection.
Give this one a try later!
a. Discard all opened or used lens care products and cosmetics.
The patient who wears contact lenses and develops infections should
discard all opened or used lens care products and cosmetics to decrease
the risk of reinfection from contaminated products.
The nurse recently admitted a patient with a diagnosis of Parkinson's disease (PD) to a
long-term care facility. Which of the following actions should the health care team
take in order to promote adequate nutrition for this patient?
a. Provide multivitamins with each meal.
b. Provide a diet that is low in complex carbohydrates and high in protein.
c. Provide small, frequent meals throughout the day that are easy to chew and
