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質問 30
A client has been in labor for 10 hours. Her contractions have become hypoactive and slowed in duration.
The fetus is at 0 station, cervix is dilated 8 cm and effaced 90%. The physician orders an oxytocin (Pitocin) infusion to be started at once. The RN begins the oxytocin infusion. It is important that the RN discontinue the infusion if which one of the following occur?

• A. Duration of the contractions are 60 seconds.
• B. The client's contractions are <2 minutes apart.
• C. The uterus relaxes between contractions.
• D. The client complains that she is tired.

正解: B

解説:
Explanation/Reference:
Explanation:
(A) It is very important that there is a resting phase or relaxation period between the contractions. During this period, the uterus, placenta, and umbilical vessels re-establish blood flow. No resting phase between contractions can lead to fetal bradycardia, fetal hypoxia, and acidosis. It can also result in a tetanic contraction, which can cause uterine rupture. (B) The goal of the oxytocin infusion is to help establish a contraction pattern lasting 45-60 seconds occurring every 2 minutes and a uterine tonus of 60-70 mm Hg.
(C) This choice is correct. The uterus has time to recover from the contraction. (D) The client's tiring is no indication to stop the infusion. She will be tired even without the infusion.

質問 31
A client is being discharged and will continue enteral feedings at home. Which of the following statements by a family member indicates the need for further teaching?

• A. "If he develops diarrhea lasting for more than 2-3 days, I will contact the doctor or nurse."
• B. "I should use prepared or open formula within 24 hours and store unused portions in the refrigerator."
• C. "I should anticipate that he will gain about 1 lb/day now that he is on continuous feedings."
• D. "It is important to keep the head of his bed elevated or sit him in the chair during feedings."

正解: C

解説:
Section: Questions Set B
Explanation:
(A) Diarrhea is a complication of tube feedings that can lead to dehydration. Diarrhea may be the result of hypertonic formulas that can draw fluid into the bowel. Other causes of diarrhea may be bacterial contamination, fecal impaction, medications, and low albumin. (B) A consistent weight gain of more than 0.22 kg/day (1ꢀ2 lb/day) over several days should be reported promptly. The client should be evaluated for fluid volume excess. (C) Elevating the client's head prevents reflux and thus formula from entering the airway. (D) Bacteria proliferate rapidly in enteral formulas and can cause gastroenteritis and even sepsis.

質問 32
The initial focus when providing nursing care for a child with rheumatic fever during the acute phase of the illness should be to:

• A. Maintain contact with her parents
• B. Maintain her interest in school
• C. Provide for physical and psychological rest
• D. Provide a nutritious diet

正解: C

解説:
Explanation
(A) This goal is helpful, but rest is essential during the acute phase. (B) Rest is essential for healing to occur and for pain to be relieved. (C) This goal is important, but rest is essential. (D) This goal should be part of the plan of care, but it is not the priority during the acute phase.

質問 33
The medication that best penetrates eschar is:

• A. Silver sulfadiazine (Silvadene)
• B. Mafenide acetate (Sulfamylon)
• C. Neomycin sulfate (Neosporin)
• D. Povidone-iodine (Betadine)

正解: B

解説:
Explanation
(A) Mafenide acetate is bacteriostatic against gram-positive and gram-negative organisms and is the agent that best penetrates eschar. (B) Silver sulfadiazine poorly penetrates eschar. (C) Neomycin sulfate does not penetrate eschar. (D) Povidoneiodine does not penetrate eschar.

質問 34
A 28-year-old woman was admitted to the hospital for a thyroidectomy. Postoperatively she is taken to the postanesthesia care unit for several hours. In preparing for the client's return to her room, which nursing measure best demonstrates the nurse's thorough understanding of possible postthyroidectomy complications?

• A. Narcotics are readily available and administered when the client returns to her room to prevent excruciating pain.
• B. Dressings are placed at the bedside for dressing changes, which are to be done every 2 hours to best detect postoperative bleeding.
• C. A tracheostomy set, O2, and suction are available at the bedside.
• D. The nurse should instruct the client as soon as possible on alternative means of communication.

正解: C

解説:
Section: Questions Set D
Explanation:
(A) Dressing changes are done as necessary for bleeding. However, frequently, post-thyroidectomy bleeding may not be visible on the dressing, but blood may drain down the back of the neck by gravity. (B) Narcotics are administered for acute pain as necessary. They are not necessarily given on return of the client to her room.
(C) The most serious postthyroidectomy complication is ineffective airway and breathing pattern related to tracheal compression and edema. A tracheostomy set, O2, and suction should be available at bedside for at least the first 24 hours postoperatively. (D) Impaired verbal communication may occur due to laryngeal edema or nerve damage, but most commonly, it occurs due to endotracheal intubation. The client is usually able to communicate but is hoarse.

質問 35
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