Nokea
A child suspected of having cystic fibrosis is scheduled for a quantitative sweat test. The nurse knows that the quantitative sweat test will be analyzed using:
- A. Pilocarpine iontophoresis
- B. Choloride iontophoresis
- C. Sodium iontophoresis
- D. Potassium iontophoresis
Correct Answer: A
Rationale: Pilocarpine iontophoresis is used to stimulate sweat production for chloride analysis in cystic fibrosis diagnosis.
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A client with newly diagnosed type I diabetes mellitus is being seen by the home health nurse. The physician orders include: 1,200-calorie ADA diet, 15 units of NPH insulin before breakfast, and check blood sugar qid. When the nurse visits the client at 5 PM, the nurse observes the man performing a blood sugar analysis. The result is 50 mg/dL. The nurse would expect the client to be
- A. confused with cold, clammy skin and a pulse of 110.
- B. lethargic with hot, dry skin and rapid, deep respirations.
- C. alert and cooperative with a BP of 130/80 and respirations of 12.
- D. short of breath, with distended neck veins and a bounding pulse of 96.
Correct Answer: A
Rationale: symptoms of hypoglycemia, normal blood sugar 70-110 mg/dL
The RN on the oncology unit is preparing to mix and administer amphoteracin B (Fungizone) to a client. Which action is contraindicated for administering this drug IV?
- A. Mix the drug with normal saline solution
- B. Administer the drug over 4-6 hours
- C. Hydrate with IV fluids 2 hours before the infusion
- D. Premedicate the client - acetaminophen (Tylenol) and diphenhydramine (Benadryl)
Correct Answer: A
Rationale: Amphotericin B should not be mixed with normal saline due to precipitation risk; it requires dextrose solutions. Slow administration, hydration, and premedication are standard to reduce side effects.
A client has surgery scheduled in 2 weeks. He decides to donate his own blood ahead of time to be stored and used in case he needs a blood transfusion during his surgery. This type of blood donation is referred to as
- A. an allogeneic donation.
- B. an xenogeneic donation.
- C. an autologous donation.
- D. a directed donation.
Correct Answer: C
Rationale: Autologous donation involves donating one’s own blood for personal use during surgery, reducing transfusion risks.
The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent contractures, the nurse should:
- A. Place the client in a prone position 15-30 minutes twice a day
- B. Keep the foot of the bed elevated on shock blocks
- C. Place trochanter rolls on either side of the affected leg
- D. Keep the client's leg elevated on two pillows
Correct Answer: A
Rationale: Prone positioning helps stretch hip flexors, preventing contractures after AKA by maintaining proper alignment.
A client with AIDS tells the nurse that he regularly takes echinacea to boost his immune system. The nurse should tell the client that:
- A. Herbals can interfere with the action of antiviral medication
- B. Supplements have proven effective in prolonging life
- C. Herbals have been shown to decrease the viral load
- D. Supplements appear to prevent replication of the virus
Correct Answer: A
Rationale: Echinacea may interact with antiretroviral medications, potentially reducing their effectiveness.