Nokea
A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question?
- A. Call for urine output <30 mL/hour for 2 consecutive hours.
- B. Metoprolol (Lopressor) 5 mg I.V. push.
- C. Symptom for a pulmonary artery catheter insertion.
- D. Titrate Dobutamine (Dobutrex) to keep systolic BP >100.
Correct Answer: B
Rationale: Metoprolol, a beta-blocker, can worsen cardiogenic shock by reducing heart rate and contractility. Other orders are appropriate for monitoring and supporting perfusion in cardiogenic shock.
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A 68-year-old client with colon cancer experiences an increase in his feelings of anxiety and depression and has suicidal ideation. He appears to be in great distress. The nurse realizes that he is at which stage in his disease?
- A. Initiation of definitive treatment.
- B. End of his first course of treatment.
- C. End stage of his disease.
- D. Recurrence of the disease.
Correct Answer: C
Rationale: Increased anxiety, depression, and suicidal ideation suggest the client is in the end stage of colon cancer, facing mortality and existential distress.
Which of the following is a priority outcome for the client with Addison's disease?
- A. Maintenance of medication compliance.
- B. Adherence to a 2-g sodium diet.
- C. Prevention of hypertensive episodes.
- D. Demonstration of effective coping skills.
Correct Answer: A
Rationale: Medication compliance is critical in Addison's disease to prevent adrenal crisis and maintain hormonal balance.
During the assessment of a client's mouth, the nurse notes the absence of saliva. The client has pain in the area of the ear. The client has been nothing-by-mouth (NPO) for several days because of the insertion of a nasogastric tube. Based on these findings, the nurse suspects that the client may be developing which of the following mouth conditions?
- A. Stomatitis.
- B. Oral candidiasis.
- C. Parotitis.
- D. Gingivitis.
Correct Answer: C
Rationale: Parotitis, inflammation of the parotid gland, is suggested by the absence of saliva and ear pain, especially in a client who is NPO and dehydrated, which can impair salivary gland function. Stomatitis, oral candidiasis, and gingivitis typically present with different symptoms, such as mucosal inflammation, white patches, or gum bleeding.
The nurse is preparing a continuing education course on blood transfusion reactions. The nurse recognizes which intervention would prevent an ABO incompatibility (hemolytic) transfusion error.
- A. Priming a Y-tubing blood administration set with 0.9% sodium chloride (normal saline).
- B. Ensure that the client has a patent 20-gauge peripheral vascular access device.
- C. Accurately label the client's blood specimen for crossmatching.
- D. Review the client's medication allergies.
Correct Answer: C
Rationale: Accurate labeling of the client’s blood specimen for crossmatching ensures the correct blood type is matched, preventing ABO incompatibility reactions. Priming with saline, ensuring IV access, and reviewing allergies do not directly prevent ABO mismatches.
Which of the following should the nurse interpret as an indication of a complication after the first few days of TPN therapy?
- A. Glycosuria.
- B. A 1- to 2-pound weight gain.
- C. Decreased appetite.
- D. Elevated temperature.
Correct Answer: D
Rationale: An elevated temperature after the first few days of TPN may indicate a complication like infection, particularly catheter-related. Glycosuria can occur with TPN but is managed, a small weight gain is expected, and decreased appetite is not a direct complication. CN: Pharmacological and parenteral therapies; CL: Analyze