Nokea
The nurse is reviewing new medication prescriptions for assigned clients. The nurse should clarify the prescription for?
- A. PO oxycodone for a client who had a total hip replacement 1 day ago, has a history of buspirone use, and is reporting pain rated as 6 on a scale of 0-10
- B. PO tramadol for a client who had a laparoscopic cholecystectomy 1 day ago, has a history of nicotine use, and is reporting pain rated as 5 on a scale of 0-10
- C. transdermal fentanyl for a client who had an above-the-knee amputation 2 days ago, has a history of cocaine use, and is reporting pain rated as 8 on a scale of 0-10
- D. transdermal lidocaine 5% for a client who has chronic postherpetic neuralgia, has a history of alcohol use, and is reporting pain rated as 7 on a scale of 0-10
Correct Answer: C
Rationale: Transdermal fentanyl is typically reserved for chronic pain, not acute postoperative pain, and requires clarification.
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The nurse is caring for the assigned clients on a pediatric inpatient unit. Which client is the priority?
- A. 8-year-old with sickle cell crisis who has sudden-onset unilateral arm weakness
- B. 11-year-old with viral meningitis requesting pain medication for headache
- C. Male child scheduled for surgery for intussusception who has reddish mucoid stool
- D. Male child with hemophilia who has hemarthrosis and is receiving desmopressin
Correct Answer: A
Rationale: Sudden unilateral arm weakness in a sickle cell crisis may indicate a stroke, a life-threatening emergency requiring immediate attention.
An adult is admitted with advanced cancer of the GI tract. What question must be included in the admission assessment?
- A. What foods do you like best?
- B. Do you have advance directives?
- C. Do you want CPR if you go into cardiac arrest?
- D. Do you understand the serious nature of your illness?
Correct Answer: B
Rationale: Advanced cancer requires discussion of end-of-life preferences. Asking about advance directives ensures the client's wishes are documented, taking priority over dietary preferences, specific CPR desires, or illness understanding.
A client with an implantable cardioverter defibrillator (ICD) develops ventricular tachycardia (VT) with a pulse while admitted to the medical-surgical unit. The ICD fires multiple times without successfully stopping the VT, causing the client to become confused and difficult to rouse. Which action by the nurse is appropriate?
- A. Attempt to stimulate a vagal response by having the client cough
- B. Deactivate the client's implantable cardioverter defibrillator with an external magnet
- C. Obtain a STAT 12-lead ECG to verify the cardiac rhythm
- D. Prepare for synchronized cardioversion with the external defibrillator
Correct Answer: D
Rationale: Persistent VT causing altered mental status requires synchronized cardioversion to restore normal rhythm.
The nurse is talking with the parent of a pediatric client with type 1 diabetes mellitus who has influenza. Which of the following statements by the parent would require follow-up?
- A. I should encourage my child to drink more fluids.
- B. I will check my child's capillary blood glucose level more frequently.
- C. I should regularly check my child's urine for ketones.
- D. I will decrease my child's prescribed dose of insulin if my child is unable to eat.
Correct Answer: D
Rationale: Decreasing insulin during illness can lead to hyperglycemia or ketoacidosis, as insulin needs may increase.
The nurse is conducting intake interviews at the clinic. Which client situations would require the nurse to intervene? Select all that apply.
- A. Client with iron deficiency anemia takes iron supplements with milk
- B. Client takes levothyroxine early in the morning on an empty stomach
- C. Client taking phenazopyridine for urine infection states that the urine has turned orange
- D. Client taking metronidazole mentions going to a wine-tasting party tonight
- E. Client with closed-angle glaucoma takes over-the-counter diphenhydramine for a cold
Correct Answer: A,D,E
Rationale: Milk reduces iron absorption, metronidazole with alcohol can cause severe reactions, and diphenhydramine can worsen closed-angle glaucoma.