a client with peptic ulcer disease is receiving ranitidine zantac the nurse should monitor the client for which of the following side effects
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Community Health HESI Test Bank

1. A client with peptic ulcer disease is receiving ranitidine (Zantac). The nurse should monitor the client for which of the following side effects?

Correct answer: C

Rationale: The correct answer is C: Diarrhea. Ranitidine, which is used to treat peptic ulcer disease, can lead to gastrointestinal disturbances such as diarrhea. Choices A, B, and D are incorrect. Hypertension and hypotension are not common side effects of ranitidine. Constipation is also not a typical side effect associated with ranitidine use.

2. A 14-month-old had cleft palate surgical repair several days ago. The parents ask the nurse about feedings after discharge. Which lunch is the best example of an appropriate meal?

Correct answer: B

Rationale: Choice B, 'Soup, blenderized soft foods, ice cream, milk,' is the correct answer. After cleft palate repair, it is essential to provide soft and blenderized foods to prevent trauma to the surgical site and promote proper healing. Choices A, C, and D contain foods that may be difficult for the child to consume comfortably and safely after a cleft palate surgical repair. A hot dog, carrot sticks, chips, and hard cookies could potentially cause injury or discomfort to the surgical area. Peanut butter and jelly sandwich might be too difficult to swallow or may stick to the surgical site. Baked chicken could be too challenging to chew. Therefore, the best choice for an appropriate meal post cleft palate repair is soft, blenderized foods like soup, along with other soft options like ice cream and milk.

3. In the preparation of your health education plan, what is the first thing to do?

Correct answer: A

Rationale: The correct answer is A: Assess community needs for health education. This is the initial step in developing a health education plan as it helps in understanding the specific requirements of the community. Identifying subjects for teaching (choice B) comes after assessing needs. Specifying goals and objectives (choice C) is crucial but typically follows the assessment of community needs. Identifying support providers and types (choice D) is important but is not the first step in preparing a health education plan.

4. A 67-year-old client is admitted with substernal chest pain with radiation to the jaw. His admitting diagnosis is Acute Myocardial Infarction (MI). The priority nursing diagnosis for this client during the immediate 24 hours is

Correct answer: C

Rationale: The correct answer is C: Impaired gas exchange. In a client with an acute myocardial infarction, impaired gas exchange is a priority nursing diagnosis due to compromised heart function, which affects oxygenated blood circulation. Close monitoring and interventions are crucial to ensure adequate oxygenation. Choices A, B, and D are incorrect: A) Constipation related to immobility is not the priority in this acute situation; B) High risk for infection is not the immediate concern related to the client's primary diagnosis; D) Fluid volume deficit, while important, is not the priority compared to addressing impaired gas exchange in acute MI.

5. When a nurse teaches a community about the importance of hand hygiene, the nurse is engaging in:

Correct answer: A

Rationale: The correct answer is A: Primary prevention. Primary prevention aims to prevent the occurrence of a disease or injury before it happens. Teaching about hand hygiene to the community helps in preventing infections from occurring in the first place. Choice B, Secondary prevention, involves early detection and treatment to halt or slow the progress of a condition. This would involve screening or early intervention after exposure. Choice C, Tertiary prevention, focuses on managing the disease to prevent complications, recurrence, or deterioration. This would include rehabilitation and monitoring to prevent further complications. Choice D, Quaternary prevention, relates to actions taken to avoid unnecessary interventions or over-medicalization. This usually involves questioning the necessity of certain medical procedures or treatments to prevent harm to patients.

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