Nokea
A client in the ICU is given procainamide HCl (Pronestyl) slowly IV push. The nurse should withhold the next dose of this medication and notify the physician if which of the following is observed on the cardiac monitor?
- A. One premature ventricular contraction (PVC).
- B. Sinus rhythm with occasional bigeminy.
- C. Persistent tachycardia of 112 beats per minute.
- D. Prolongation of the QT interval.
Correct Answer: D
Rationale: prolongation of the QT interval is a side effect that can lead to torsades de pointes, a life-threatening arrhythmia
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The nurse in the ER has received report of four clients en route to the emergency department. Which client should the nurse see first? A client with:
- A. Third-degree burns to the face and neck area, with singed nasal hairs
- B. Second-degree burns to each leg and thigh area, who is alert and oriented
- C. A chemical burn that has been removed and liberally flushed before admission
- D. An electrical burn entering and leaving on the same side of the body
Correct Answer: A
Rationale: Third-degree burns to the face and neck with singed nasal hairs suggest airway burns, a life-threatening condition requiring immediate airway assessment and management.
Based on clinical findings, the physician suspects that a 65-year-old client has kidney disease and has ordered a blood-urea-nitrogen (BUN) test. Which of the following results is within normal limits?
- A. 5 mg/dL
- B. 15 mg/dL
- C. 40 mg/dL
- D. 100 mg/dL
Correct Answer: B
Rationale: Normal BUN is 7-20 mg/dL, so 15 mg/dL (B) is within range. Other values (A, C, D) are too low or high.
One week after discharge of a postpartum client, the client's husband calls the postpartum unit and asks the nurse, 'Is it normal for my wife to cry at the drop of a hat? I'm worried I've done something to upset her.' The nurse's best initial response would be:
- A. Have you noticed any pattern to her periods of crying?
- B. Try not to worry about it. I'm sure it's just the postpartum blues.
- C. Can you think of something you might have done to upset her?
- D. Let's consider some of the ways you can decrease her depression.
Correct Answer: B
Rationale: Postpartum blues are common within the first two weeks, characterized by emotional lability. Reassuring the husband while acknowledging the normalcy of this condition is appropriate.
A client admitted with gastroenteritis and a potassium level of 2.9 mEq/dL has been placed on telemetry. Which ECG finding would the nurse expect to find due to the client's potassium results?
- A. A depressed ST segment
- B. An elevated T wave
- C. An absent P wave
- D. A flattened QRS
Correct Answer: A
Rationale: Hypokalemia (2.9 mEq/dL) can cause a depressed ST segment, flattened T waves, and prominent U waves on ECG due to altered cardiac repolarization.
The home health care nurse is caring for a 30-year-old woman with type I diabetes mellitus. The client has been maintained on a regimen of NPH and regular insulin and a 1,800-calorie diabetic diet with normal blood sugar levels. Morning self-monitoring blood sugar (SMBG) readings the past two days were 205 mg/dL and 233 mg/dL. The nurse expects the physician to
- A. reduce the client’s diet to 1,500 calorie ADA.
- B. order 3 additional units of NPH insulin at 10 PM.
- C. order an additional 10 units of regular insulin at 8 PM.
- D. eliminate the client’s bedtime snack.
Correct Answer: B
Rationale: dawn phenomena, treatment is to adjust evening diet, bedtime snack, insulin dose, and exercise to prevent early morning hyperglycemia