Nursing Care and Patient Behavior

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Questions and Answers

What is the most critical action a nurse must take before administering enteral feeding through a nasogastric tube?

Ensure that feeding solution is at room temperature

Aspirate abdominal contents to determine the amount of last feeding remaining

Verify correct placement of the tube (correct)

Check that the feeding solution matches the dietary order

Which method is considered definitive for confirming the placement of a nasogastric tube?

Checking pH level of aspirated contents

Aspirating stomach contents

Visualizing the tube's position via x-ray (correct)

Observing client's comfort level

If a nurse needs to check the placement of a nasogastric tube without x-ray, which alternative method is appropriate?

Aspirate stomach contents and check for bilirubin (correct)

Monitor the patient's respiratory rate

Check the patient’s oral intake record

Palpate the abdomen for solid contents

What could occur if the nasogastric tube is improperly placed?

Increased risk of aspiration Signup and view all the answers

During a community meeting, what should the nurse primarily focus on when discussing chiropractic treatment?

Spinal column manipulation Signup and view all the answers

What is one of the methods to check the pH of aspirated contents from a nasogastric tube?

Using a colorimetric test Signup and view all the answers

What is a potential outcome of using improper feeding solutions for enteral feeding?

Increased gastrointestinal distress Signup and view all the answers

Which of the following signs would indicate a possible aspiration in a patient receiving enteral feeding?

Coughing or gagging during feeding Signup and view all the answers

Which sign indicates that the morphine drip pump delivering a basal rate may not be functioning properly?

The level of the drug is 100 ml at 8 AM and is 80 ml at noon Signup and view all the answers

What is the expected volume of morphine to be remaining in the drip container at noon, given the pump's rate?

60 ml Signup and view all the answers

What immediate action should be taken if the client reports they cannot get relief from pain while on a morphine drip?

Check the pump for malfunctions Signup and view all the answers

If a patient using a morphine pump shows an increase in pain despite normal dosages, which factor is the least likely to affect the pump's effectiveness?

Proper calibration of the infusion pump Signup and view all the answers

What is not a recommended practice regarding client care when using oil-based cosmetics?

Applying oil-based makeup Signup and view all the answers

What is a potential danger of consuming large, heavy meals for someone with coronary artery disease?

Blood being directed away from the heart Signup and view all the answers

Which laboratory result indicates a condition that requires immediate intervention for a patient with diabetic ketoacidosis?

Serum potassium level of 2.8 mEq/L Signup and view all the answers

Which factor is identified as a risk factor for primary hypertension in African Americans?

Race Signup and view all the answers

What effect does plaque accumulation in arteries have on the body?

May block blood and oxygen delivery to major organs Signup and view all the answers

What condition is indicated by a serum potassium level of 2.8 mEq/L?

Hypokalemia Signup and view all the answers

Which of the following lifestyle factors may reduce the risk of hypertension?

High-intensity exercise Signup and view all the answers

What aspect of African American demographics is associated with higher risk for hypertension?

Genetic predisposition Signup and view all the answers

What is the normal blood potassium range that should not require immediate intervention?

3.5-5.0 mEq/L Signup and view all the answers

What is the primary theory underlying chiropractic care?

Interference with mental impulses causes diseases. Signup and view all the answers

Which action is considered a violation of surgical asepsis during wound care?

Pouring solution onto a sterile field cloth. Signup and view all the answers

Which nursing diagnosis is most appropriate for the caregiver of a client with chronic cognitive impairment?

Caregiver role strain. Signup and view all the answers

What does the term 'subluxation' refer to in chiropractic theory?

A misalignment of vertebrae affecting nerve function. Signup and view all the answers

Which of the following practices ensures surgical asepsis?

Using sterile gloves when handling sterile equipment. Signup and view all the answers

How might chronic cognitive impairment manifest in a patient?

Confusion and wandering tendencies. Signup and view all the answers

Why is considering a 1″ (2.5-cm) edge around a sterile field as contaminated important?

It prevents the spread of infection. Signup and view all the answers

What is a potential consequence of interference in the transmission of mental impulses?

Diseases in body organs. Signup and view all the answers

Which risk is least likely for a patient with poorly fitting dentures and type 2 diabetes?

Hyperglycemia Signup and view all the answers

What should the nurse emphasize regarding meals for a client with coronary artery disease?

Avoiding very heavy meals Signup and view all the answers

What is a likely dietary concern for a patient with denture problems?

Difficulty consuming solid foods Signup and view all the answers

Which aspect of diet management is critical for a client with type 2 diabetes?

Monitoring carbohydrate intake Signup and view all the answers

Patients with poorly fitting dentures may experience which of the following nutritional issues?

Inadequate nutrition Signup and view all the answers

What should be a dietary focus for older adults with diabetes and denture challenges?

Liquid or pureed foods Signup and view all the answers

For a client with coronary artery disease, which dietary change should be avoided?

Frequent snacking Signup and view all the answers

In managing diabetes, which symptom is likely more prevalent due to dietary challenges?

Hypoglycemia Signup and view all the answers

Study Notes

Patient Care and Diet Considerations

Predictable behavior is less stressful for patients, aiding in better functioning with daily activities (ADLs).
For a 70-year-old with poorly fitting dentures and type 2 diabetes, the least likely risk is hyperglycemia; hypoglycemia is more probable.
Patients with dental issues often can only manage liquid or pureed foods, increasing the risk of malnutrition and dehydration.

Nutrition Education for Coronary Artery Disease

Important to advise patients with coronary artery disease to avoid heavy meals to prevent blood from diverting from the heart necessary for digestion.
Accumulation of plaque in arteries from poor eating habits can hinder oxygen delivery to vital organs.

Laboratory Values and their Significance

A serum potassium level of 2.8 mEq/L indicates hypokalemia and requires immediate intervention.
Other values such as finger stick glucose of 70 mg/dL, serum osmolality of 280 mOsm/kg, and blood ketones of 0.3 mg/dL are within normal limits.

Risk Factors for Hypertension

An African American male, aged 45, may face heightened risk for primary hypertension due to race.
Low serum lipids and an active lifestyle are not factors that increase risk.

Enteral Feeding Procedures

The first priority when administering enteral feeding via a nasogastric tube is to verify the correct placement to prevent aspiration.
Tube placement can be confirmed by X-ray, aspirating stomach contents for pH testing, and verifying for bilirubin.

Chiropractic Treatment Insights

Chiropractic care focuses on spinal column manipulation, addressing issues related to the vertebrae that could interfere with organ function.

Surgical Asepsis Violations

Pouring solution onto a sterile field cloth breaches surgical asepsis; moisture can carry microorganisms into sterile areas.
Maintaining sterility includes holding objects above the waist and recognizing contaminated edges.

Cognitive Impairment and Caregiver Support

For an 80-year-old patient with chronic cognitive impairment, a fitting nursing diagnosis for the caregiver is caregiver role strain, reflecting the demands placed on them.

Pain Management and IV Pumps

In pain management, if drug levels at set intervals (e.g., 100 ml at 8 AM and 80 ml at noon) show less than expected, the pump may not be delivering medication effectively.
Understanding expected dosages assists in recognizing pump malfunctions and addressing patient discomfort promptly.

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Description

This quiz explores the relationship between predictable behavior and patient care in nursing. It highlights how understanding patients' abilities to perform Activities of Daily Living (ADLs) can enhance care. Test your knowledge on effective nursing strategies that support patient functionality.