Nokea
A client is receiving IV Dopamine for the treatment of shock. Which of the following findings indicates that the medication is effective?
- A. Increased heart rate
- B. Decreased blood pressure
- C. Increased urine output
- D. Decreased respiratory rate
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A healthcare provider is preparing to administer a transfusion of a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?
- A. Ensure that the client has a patent IV line before obtaining the blood product from the refrigerator.
- B. Obtain help from another healthcare provider to confirm the correct client and blood product.
- C. Take a complete set of vital signs before beginning the transfusion and periodically during the transfusion.
- D. Stay with the client for the first 15 to 30 minutes of the transfusion.
Correct Answer: B
Rationale: The correct answer is to obtain help from another healthcare provider to confirm the correct client and blood product. This action is crucial in preventing an acute hemolytic reaction, which is caused by ABO or Rh incompatibility. Verifying the correct client and blood product before the transfusion ensures that there are no errors in identification, reducing the risk of a potentially life-threatening reaction.
A nurse is providing discharge instructions to a client who is prescribed Warfarin. Which of the following dietary instructions should the nurse include?
- A. Increase your intake of leafy green vegetables.
- B. Avoid foods high in vitamin K.
- C. Increase your intake of dairy products.
- D. Avoid foods high in iron.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A healthcare professional is monitoring a client who is receiving spironolactone. Which of the following findings should the professional report to the provider?
- A. Serum Sodium 144 mEq/L
- B. Urine output 120 mL in 4 hr
- C. Serum Potassium 5.2 mEq/L
- D. Blood Pressure 140/90 mm Hg
Correct Answer: C
Rationale: A serum potassium level of 5.2 mEq/L indicates hyperkalemia. Spironolactone is a potassium-sparing diuretic that can cause potassium retention. Hyperkalemia is a serious condition that can lead to cardiac dysrhythmias. The healthcare professional should withhold the medication and promptly notify the provider to prevent potential complications.
A client is receiving spironolactone. Which of the following findings should the nurse report to the provider?
- A. Serum Sodium 144 mEq/L
- B. Urine output 120 mL in 4 hr
- C. Serum Potassium 5.2 mEq/L
- D. Blood Pressure 140/90 mm Hg
Correct Answer: C
Rationale: A serum potassium level of 5.2 mEq/L indicates hyperkalemia. Spironolactone is a potassium-sparing diuretic that can lead to potassium retention. The nurse should notify the provider and withhold the medication to prevent further elevation of potassium levels, which can result in serious cardiac complications.
When instructing a client with a new prescription for Timolol on how to insert eye drops, which area should the nurse instruct the client to press on to prevent systemic absorption of the medication?
- A. Bony orbit
- B. Nasolacrimal duct
- C. Conjunctival sac
- D. Outer canthus
Correct Answer: B
Rationale: Pressing on the nasolacrimal duct, located near the inner corner of the eye, blocks the lacrimal punctum and prevents the medication from entering the systemic circulation. This technique helps to ensure the medication stays localized in the eye, enhancing its therapeutic effect while minimizing systemic side effects.