Nokea
A client is receiving end-of-life care and tells the nurse that he has not always lived the way he should have or treated his children well. Which of the following responses is the most appropriate?
- A. What kinds of things have you done?'
- B. There are things that you regret.'
- C. I'm sure those things don't matter anymore.'
- D. It's not too late to ask for forgiveness.'
Correct Answer: B
Rationale: Reflecting that the client has regrets (B) is empathetic and opens further discussion without judgment. Asking for details (A), dismissing concerns (C), or suggesting forgiveness (D) may not be appropriate.
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The nurse is reviewing medication orders for his clients. Which order would necessitate contacting the health care provider?
- A. Paxil (paroxetine) 20 mg PO daily for a 57-year-old client with social anxiety disorder
- B. Phenergan (promethazine hydrochloride) 12.5 mg PR q12h prn for a child with Reye's syndrome
- C. Diflucan (fluconazole) 150 mg x 1 dose PO for a 24-year-old client with vaginal candidiasis
- D. Lopressor (metoprolol tartrate) 50 mg PO daily for a 48-year-old client with hypertension
Correct Answer: B
Rationale: Promethazine is contraindicated in children with Reye’s syndrome due to the risk of worsening neurological symptoms. Other orders are appropriate.
The doctor has prescribed Cortone (cortisone) for a client with systemic lupus erythematosis. Which instruction should be given to the client?
- A. Take the medication 30 minutes before eating.
- B. Report changes in appetite and weight.
- C. Wear sunglasses to prevent cataracts.
- D. Schedule a time to take the influenza vaccine.
Correct Answer: B
Rationale: Cortisone can cause weight gain and appetite changes, which should be monitored in SLE to manage side effects.
An 8-year-old client is returned to the recovery room after a bronchoscopy. The nurse should position the client
- A. in semi-Fowler’s position.
- B. prone, with the head turned to the side.
- C. with the head of the bed elevated 45° and the neck extended.
- D. supine, with the head in the midline position.
Correct Answer: A
Rationale: check vital signs every 15 minutes until stable, assess for respiratory difficulty (stridor and dyspnea resulting from laryngeal edema or laryngospasm)
A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse?
- A. Meperidine 100 mg IM q 4 hours PRN pain
- B. Mylanta 30 ccs q 4 hours via NG
- C. Cimetadine 300 mg PO q.i.d.
- D. Morphine 8 mg IM q 4 hours PRN pain
Correct Answer: D
Rationale: Morphine can cause sphincter of Oddi spasm, worsening pancreatitis pain, so it should be questioned; meperidine is preferred.
The nurse is monitoring a client’s EKG strip and notes coupled premature ventricular contractions greater than 10 per minute. The nurse should expect to administer which of the following?
- A. Atropine sulfate (Atropine) IV.
- B. Isoproterenol (Isuprel) IV.
- C. Verapamil (Calan) IV.
- D. Lidocaine hydrochloride (Xylocaine) IV.
Correct Answer: D
Rationale: Lidocaine is the drug of choice for frequent premature ventricular contractions (PVC) occurring in excess of 6-10 per minute; for coupled PVCs or for a consecutive series of PVCs that may result in ventricular tachycardia