Nokea
A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the client's history requires follow-up by the nurse?
- A. Metal hip prosthesis was placed twenty years ago.
- B. Takes metformin hydrochloride for type 2 diabetes mellitus.
- C. Report of client's sobriety for the last five years.
- D. CT scan that was performed six months earlier.
Correct Answer: B
Rationale: Metformin use requires follow-up due to the risk of lactic acidosis with contrast agents affecting renal function. Metal prostheses, sobriety, and prior CT scans are less relevant to contrast administration safety.
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The nurse is caring for a client with hypertension, gastroesophageal reflux, and osteoarthritis. While performing a bedside assessment, the nurse observes the client is alert and oriented, but is exhibiting signs of jaundice. The nurse should notify the healthcare provider about which scheduled medication?
- A. Captopril.
- B. Acetaminophen.
- C. Omeprazole.
- D. Prednisone.
Correct Answer: B
Rationale: Acetaminophen can cause liver toxicity, manifesting as jaundice, especially with high doses. Captopril, omeprazole, and prednisone are less commonly associated with jaundice.
During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?
- A. Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed.
- B. Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
- C. Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's safety.
- D. Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's insomnia.
Correct Answer: B
Rationale: Insomnia is a common, often temporary side effect of rivastigmine. Explaining this reassures the caregiver. Rivastigmine is for cognition, not sleep, and withholding or increasing the dose is inappropriate without provider guidance.
Before administering the initial dose of sumatriptan succinate to a client with a migraine headache, it is most important to determine if the client's history includes which problem?
- A. Coronary artery disease.
- B. Irritable bowel syndrome.
- C. Seasonal allergic rhinitis.
- D. Type 2 diabetes mellitus.
Correct Answer: A
Rationale: Sumatriptan causes vasoconstriction, which can exacerbate coronary artery disease, making this history critical to assess. IBS, rhinitis, and diabetes are not contraindications.
An older client with heart failure (HF), coronary artery disease (CAD), and hypertension (HTN), is receiving these daily prescriptions: atenolol, furosemide, and enalapril. Which assessments should the nurse include in evaluating the effectiveness of the medications? (Select all that apply.)
- A. Bowel sounds.
- B. Daily weight.
- C. Heart sounds.
- D. Blood pressure.
- E. Range of motion.
Correct Answer: B,C,D
Rationale: B: Daily weight monitors fluid retention (furosemide effectiveness). C: Heart sounds assess heart failure control (atenolol, enalapril). D: Blood pressure evaluates hypertension management (atenolol, enalapril). Bowel sounds and range of motion are unrelated to these medications’ effects.
History and physical
The client is a 26-year-old female with acute appendicitis. She has a 12 year history of type 1 diabetes mellitus and no other significant medical history. The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.
Nurses notes
0730
Admitted the client. She is awake and alert. She rates her pain 2 on a 0 to 10 pain scale. Her pulses are equal bilaterally. Heart rate is 76 beats/minute, normal sinus rhythm. Her oxygen saturation is 100% on room air. She has a gauze dressing over her surgical site, which is clean and dry. Her temperature is 98.5° F (37.0° C) orally. She urinated 50 mL upon arrival in the unit and is reporting she
Lab results
Blood glucose 279mg/dl
Flowsheet
0745
2 units insulin lispro given.
1800
12 units insulin glargine given.
Orders
0730
• Admit to the surgical floor
• Dextrose 5% and 0.9% sodium chloride IV to infuse at 125 mL/hr
-Advance diet as tolerated
• Insulin glargine 12 units SUBQ every 24 hours
. Ceftriaxone 2 gram IV piggy back (IVPB) every 24 hours for 3 days, first dose given in surgery
Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse should expect for the insulin glargine to start working in ------------------ and to continue working for---------------------------.
- A. 2 hours
- B. 24 hours
- C. 6 hours
- D. 30 minutes
- E. 8 hours
Correct Answer: A,B
Rationale: Insulin glargine starts working in about 2 hours and lasts approximately 24 hours, providing steady basal insulin.