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A client is prescribed diphenhydramine 1% as a topical agent for allergic dermatosis. The nurse evaluates that the medication is having the intended effect when the client reports relief of what complaint?
- A. Pain
- B. Urticaria
- C. Headache
- D. Skin redness
Correct Answer: B
Rationale: Diphenhydramine is an antihistamine medication that has many uses. When used as a topical agent on the skin, it reduces the symptoms of allergic reaction, such as itching or urticaria. It does not act to relieve pain, headache, or skin redness.
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A client with a history of chronic kidney disease is admitted with hyperkalemia. The nurse should prioritize which of the following interventions?
- A. Administer insulin and glucose.
- B. Restrict potassium-rich foods.
- C. Administer a loop diuretic.
- D. Monitor for dysrhythmias.
Correct Answer: D
Rationale: Monitoring for dysrhythmias is the priority, as hyperkalemia can cause life-threatening cardiac arrhythmias.
A school-age child diagnosed with attention deficit hyperactivity disorder is prescribed methylphenidate (Ritalin). Which of the following should alert the school nurse to the possibility that the child is experiencing a common side effect of the drug?
- A. Loss of appetite
- B. Vomiting
- C. Photosensitivity
- D. Weight gain
Correct Answer: A
Rationale: Loss of appetite is a common side effect of methylphenidate, often leading to weight loss. Vomiting and photosensitivity are less common, and weight gain is not typical.
A client with a new diagnosis of hypothyroidism is prescribed levothyroxine. What should the nurse include in the teaching plan?
- A. Take the medication at bedtime.
- B. Expect weight gain as a side effect.
- C. Report palpitations or chest pain.
- D. Stop the medication if nausea occurs.
Correct Answer: C
Rationale: Palpitations or chest pain may indicate overmedication or cardiac effects, requiring prompt reporting to adjust the levothyroxine dose.
Which of the following is a commonality that is shared in terms of both restraints and urinary catheters?
- A. Both can lead to infection.
- B. Both are invasive procedures.
- C. Both are considered sentinel.
- D. Both are the last resort.
Correct Answer: A
Rationale: Both restraints and urinary catheters can lead to infections restraints via skin breakdown and catheters via urinary tract infections if not properly managed.
During the health history interview, which of the following strategies is the most effective for the nurse to use to help clients feel that they have an active role in their health care?
- A. Ask clients to complete a questionnaire.
- B. Provide clients with written instructions.
- C. Ask clients for their description of events and for their views concerning past medical care.
- D. Ask clients if they have any questions.
Correct Answer: C
Rationale: Engaging clients by asking for their description of events and views on past medical care promotes active participation, fosters trust, and ensures the nurse understands the client's perspective, which is critical for patient-centered care.