Nokea
A client in the emergency department has Benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority?
- A. Administer flumazenil.
- B. Identify the client's level of orientation.
- C. Infuse IV fluids.
- D. Prepare the client for gastric lavage.
Correct Answer: B
Rationale: In a situation where a client presents with Benzodiazepine toxicity, the priority action for the nurse is to assess the client. By identifying the client's level of orientation, the nurse can gather crucial information about the client's mental status, which is essential for determining the appropriate care and interventions needed. Administering flumazenil, infusing IV fluids, or preparing for gastric lavage may be necessary interventions but should follow a thorough assessment of the client's condition.
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A client is prescribed furosemide. Which of the following instructions should the nurse include in the teaching?
- A. Take this medication in the morning.
- B. Avoid eating foods high in potassium.
- C. You should take this medication on an empty stomach.
- D. Limit your fluid intake to 1 liter per day.
Correct Answer: A
Rationale: The correct instruction for a client prescribed furosemide is to take the medication in the morning. Furosemide, a diuretic, is best taken in the morning to prevent nocturia, which is excessive urination at night. Taking it earlier in the day can help reduce disruptions to sleep patterns. Therefore, advising the client to take furosemide in the morning is crucial for optimal therapeutic effects.
A client is starting therapy with cisplatin, and a healthcare provider is providing education. Which of the following findings should the healthcare provider instruct the client to report?
- A. Tinnitus
- B. Nausea
- C. Constipation
- D. Weight gain
Correct Answer: A
Rationale: The correct answer is A: Tinnitus. The healthcare provider should instruct the client to report tinnitus, as it can be an indication of ototoxicity, an adverse effect associated with cisplatin therapy. Ototoxicity is damage to the inner ear structures that can lead to hearing loss, making it crucial for the client to report any early signs such as tinnitus to prevent further complications.
A client has a prescription for Bethanechol to treat urinary retention. Which of the following findings is a manifestation of muscarinic stimulation?
- A. Dry mouth
- B. Hypertension
- C. Excessive perspiration
- D. Fecal impaction
Correct Answer: C
Rationale: Bethanechol is a muscarinic agonist that stimulates muscarinic receptors. Activation of muscarinic receptors can lead to excessive perspiration (diaphoresis) due to increased cholinergic activity, affecting sweat glands. Dry mouth, hypertension, and fecal impaction are not typically associated with muscarinic stimulation.
A client is being assessed by a healthcare provider while taking Digoxin to manage heart failure. Which of the following findings is a manifestation of digoxin toxicity?
- A. Bruising
- B. Report of metallic taste
- C. Muscle pain
- D. Report of anorexia
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with increased intracranial pressure is receiving Mannitol. Which finding should the nurse report to the provider?
- A. Blood glucose 150 mg/dL
- B. Urine output 40 mL/hr
- C. Dyspnea
- D. Bilateral equal pupil size
Correct Answer: C
Rationale: Dyspnea is a concerning finding in a client receiving Mannitol as it can be a manifestation of heart failure, which is an adverse effect of the medication. The nurse should promptly notify the provider, discontinue the Mannitol, and initiate appropriate interventions to address the dyspnea and monitor the client's condition closely.