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《Kaplan NCLEX-RN Question Trainer Test-1》(947-949)

发表日期:2016-12-17 | 来源 :国际护士网 | 作者 :www.the-nurses.com |点击数: 次 收听:
 
947. The nurse is caring for a patient with second- and third-degree burns. The client is receiving morphine sulfate 15 mg IV. The nurse notes a decrease in bowel sounds and slight abdominal distention. Which of the following actions, if taken by the nurse, is BEST?

1. Recommend that the morphine dose be decreased.
2. Withhold the pain medication.
3. Administer the medication by another route.
4. Explore alternative pain management techniques.

Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?

(1) could indicate a possible impending ileus, this option is not ideal
(2) inappropriate
(3) inappropriate
(4) correct—morphine is drug of choice for burn pain management; when side effect becomes apparent, exploration of alternative pain management techniques such as visualization becomes important 
Preparation for the Nursing Licensure Examination

 948. The visiting nurse evaluates the progress of a client recently diagnosed with insulin-dependent diabetes mellitus (IDDM). As part of the treatment plan, the client receives Humulin N 32 units and Humulin R 8 units each morning. Which of the following actions, if performed by the client while preparing the morning insulin injection, would require an intervention by the nurse?

1. After the client draws up 8 units of Humulin R, she adds Humulin N to the syringe for a total of 40 units.
2. The client draws up 32 units of the clear insulin followed by 8 units of cloudy insulin for a total of 40 units.
3. Initially, the client injects air into the Humulin N vial without drawing up any insulin.
4. The client injects air into each bottle of insulin equal to the amount of insulin to be withdrawn.

Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?

(1) clear insulin always drawn up first
(2) correct—Humulin R is clear and drawn up first, only 8 units are ordered, Humulin N is cloudy
(3) allows you to withdraw medication later
(4) allows you to withdraw medication later

949. Which of the following statements by the client BEST indicates to the nurse an emotional readiness for surgery?

1. “I know the doctor isn’t telling me everything, but at this point I can’t do anything about it.”
2. “I've never heard of this specialist before. Does he do much work here?”
3. “I'm glad the trapeze is on my bed so I can start working on my exercises as soon as I wake up.”
4. “Can you please check my record to be sure it says I’m diabetic?”

Strategy: Think about each answer choice.

(1) indicates feelings of fear and helplessness
(2) indicates fear and lack of trust
(3) correct—indicates acceptance and a readiness to participate in postoperative care
(4) indicates fear that something will be missed
  

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