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Nclex Question of the Day - Question Number (45) The nurse is assisting the physician with the insertion of an esophageal tamponade. Before insertion, the nurse should: a) Inflate and deflate the gastric and esophageal balloons . b) Measure tip of of the client's nose to the xiphoid process . c) Explain that tube will remain in place for 5-7 days . d) Insert a nasogastric tube for gastric suction correct amswer a) Inflate and deflate the gastric and esophageal balloons . RATIONALE : Unless the manufacturer recommends otherwise, the nurse should inflate and deflate the gastric and esophageal balloons to make sure they are not defective. Answer B refers to the insertion of a standard nasogastric tube; therefore, it is incorrect. Answer C is incorrect because the esophageal tamponade is usually removed after 48 hours. Answer D is incorrect because theesophageal tamponade has a port for gastric suction. correct amswer B) Diarrhea . rationale : Lactulose is given to produce diarrhea, which lowers the client's serum ammonia levels. Answers A, C, and D are not associated with the use of lactulose; there, they are incorrect. #nursingstudenttips #nursing #nursingstudent #nursingschool #studentlife #student #medicalstudent #nurseintraining #nurselife #clinical #scrubslife #studygram #medical #nursingproblems #school #studentnurse #nurse #scrubs #nurseinprogress #nursingtips #nursingschoolproblems #nurseblog #secondyear #university #nurseinsta #nursingnotes #nursingblog #instablogger #insta #giveaway
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An adolescent primigravida who is 10 weeks pregnant attends the
antepartal clinic for her first check- up. To develop a teaching plan, the nurse should initially assess:
a) The client's knowledge of the signs of preterm labor .
b)The client's feelings about the pregnancy .
c) Whether the client was using a method of birth control .
d) The client's though about future children .
correct answer b)The client's feelings about the pregnancy .
rationale :
The client who is 10 weeks pregnant should be assessed to determine how she feels about the pregnancy. Answer A is incorrect because it is too early to discuss preterm labor. Answer C is incorrect because it is too late to discuss whether
she was using a method of birth control. Answer D is incorrect because now is not the time to future children; this can be
done after client delivers.