Nokea
Which of the following is a common side effect of the drug metformin?
- A. Weight loss
- B. Weight gain
- C. Drowsiness
- D. Hypertension
Correct Answer: A
Rationale: The correct answer is A, weight loss. Metformin is commonly associated with weight loss rather than weight gain. Metformin works by decreasing glucose production in the liver and improving insulin sensitivity, which can lead to weight loss in some individuals. Choices B, C, and D are incorrect. Weight gain is not a typical side effect of metformin. Drowsiness and hypertension are also not commonly associated with metformin use.
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The nurse writes a problem of "potential for complication related to ovarian hyperstimulation" for a client who is taking clomiphene (Clomid), an ovarian stimulant. Which intervention should be included in the plan of care?
- A. Instruct the client to delay intercourse until menses
- B. Schedule the client for frequent pelvic sonograms
- C. Explain that the infusion therapy will take 21 days
- D. Discuss that this may cause an ectopic pregnancy
Correct Answer: B
Rationale: Frequent pelvic sonograms help monitor for ovarian hyperstimulation, a serious potential side effect of clomiphene. Instructing the client to delay intercourse until menses (Choice A) is not directly related to monitoring for ovarian hyperstimulation. Explaining the duration of infusion therapy (Choice C) is not relevant to monitoring for this specific complication. Discussing the risk of ectopic pregnancy (Choice D) is important, but it is not the most appropriate intervention for monitoring ovarian hyperstimulation.
A patient with a history of gout should avoid which type of food?
- A. Red meat
- B. Chicken
- C. Fish
- D. Dairy
Correct Answer: A
Rationale: A patient with a history of gout should avoid foods high in purines, which can exacerbate gout attacks. Red meat is particularly high in purines, so it is the type of food that should be avoided. Chicken and fish are lower in purines compared to red meat, making them better choices for individuals with gout. Dairy products are generally not associated with triggering gout attacks, so they can be consumed in moderation by patients with gout.
The nurse is teaching the client with peripheral vascular disease. Which intervention should the nurse discuss with the client?
- A. Keep the area between the toes dry.
- B. Wear comfortable, well-fitting shoes.
- C. Cut toenails straight across.
- D. A,B
Correct Answer: D
Rationale: The correct interventions for a client with peripheral vascular disease include keeping the area between the toes dry to prevent moisture-related skin issues and wearing comfortable, well-fitting shoes to prevent injury and promote circulation. Cutting toenails straight across is important to prevent ingrown toenails, but in this case, an arch cut can lead to injury. Therefore, choices A and B are correct, making option D the most appropriate answer. Choice C is incorrect in this context.
The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first?
- A. Call a code immediately
- B. Assess the client for a pulse
- C. Begin chest compressions
- D. Continue to monitor the client
Correct Answer: B
Rationale: The correct answer is to assess the client for a pulse. In ventricular tachycardia, the priority is to determine if the client has a pulse. If there is no pulse, immediate initiation of CPR with chest compressions is required. Calling a code or continuing to monitor the client can delay life-saving interventions. Therefore, assessing for a pulse is the most crucial step in managing ventricular tachycardia.
In a routine sputum analysis, which of the following indicates proper nursing action before sputum collection?
- A. Secure a clean container
- B. Discard the container if the outside becomes soiled
- C. Rinse the client's mouth with water after collection
- D. Tell the client that 4 tablespoons of sputum are needed
Correct Answer: A
Rationale: Corrected Rationale: Before sputum collection, it is crucial to use a clean container to prevent specimen contamination. This step is essential to ensure accurate test results and to avoid introducing external particles or bacteria into the sample. Choice B is incorrect because discarding the container if the outside becomes soiled is not a standard practice before collection. Choice C is incorrect as rinsing the client's mouth with Listerine after collection can introduce unnecessary substances into the specimen. Choice D is incorrect as the amount of sputum needed should be determined by the healthcare provider, not the client.