Nokea
A client is being discharged with a prescription for chlorpromazine (Thorazine). Before leaving for home, which of these findings should the nurse teach the client to report?
- A. Change in libido, breast enlargement
- B. Sore throat, fever
- C. Abdominal pain, nausea, diarrhea
- D. Dyspnea, nasal congestion
Correct Answer: B
Rationale: A sore throat and fever may be findings of agranulocytosis, a serious side effect of chlorpromazine (Thorazine).
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The HCP prescribes metronidazole 0.5 g orally three times daily for the client with an infection. The label states that each tablet is 250 mg. How many tablets should the nurse prepare to administer for one dose?
Correct Answer: 2
Rationale: 0.5 g = 500 mg; 500 mg/ 250 mg/tablet = 2 tablets per dose.
The charge nurse is planning hospital bed placements for the five male clients identified in the exhibit. Two double rooms and one private room are available. Which room assignments should be made by the charge nurse?
- A. Client B: private room; clients C and E in same room; clients A and D in same room
- B. Client C: private room; clients A and D in same room; clients B and E in same room
- C. Client E: private room; clients B and C in same room; clients A and D in same room
- D. Client C: private room; clients A and B in same room; clients D and E in same room
Correct Answer: B
Rationale: B: Client C requires airborne precautions and a private room. A and D share the same organism and contact precautions. B and E require standard precautions and can share a room.
The nurse is caring for a client undergoing the placement of a central venous catheter line. Which of the following would require the nurse's immediate attention?
- A. Pallor
- B. Increased temperature
- C. Dyspnea
- D. Involuntary muscle spasms
Correct Answer: C
Rationale: Dyspnea. Clients having the insertion of a central venous catheter are at risk for tension pneumothorax. Dyspnea, shortness of breath and chest pain are indications of this complication.
The nurse is teaching the client to select foods rich in potassium to help prevent digitalis toxicity. Which choice indicates the client understands dietary needs?
- A. three apricots
- B. medium banana
- C. navel orange
- D. baked potato
Correct Answer: D
Rationale: baked potato. A baked potato contains 610 milligrams of potassium.
The nurse assesses the hospitalized client and surveys the client's room. The client is Muslim. Which findings require the nurse's immediate attention to remove possible sources of infection? Select all that apply.
- A. A capped bottle of saline solution with a label stating that it was opened 10 hours ago.
- B. The abdominal dressing is saturated and seeping through to the client's gown and bed.
- C. An infusing intravenous (IV) tubing has no notation of the date when it was last changed.
- D. A container located in the bathroom that is labeled urine and has the client's initials.
- E. Opened packages of gauze sponges and abdominal pads sitting on the window sill.
- F. An uncovered cup of figs on the bedside table brought by a family member last evening.
Correct Answer: B,C,E,F
Rationale: B: A saturated dressing can harbor microorganisms, increasing infection risk. C: Unknown IV tubing change dates pose a risk as tubing should be changed every 72-96 hours. E: Opened dressing packages are contaminated and unsuitable for use. F: Uncovered food can attract microorganisms, requiring immediate attention.