Nokea
A client is taking sucralfate. Which of the following client statements indicates an understanding of the teaching?
- A. I should take this medication 1 hour before meals.
- B. I should take this medication 30 minutes after meals.
- C. I should take this medication only when I have symptoms of heartburn.
- D. I should take this medication with a glass of milk.
Correct Answer: A
Rationale: The correct answer is A. Sucralfate is most effective when taken 1 hour before meals to protect the stomach lining. Option B is incorrect because sucralfate should not be taken after meals. Option C is incorrect because sucralfate is typically taken on a regular schedule, not just when symptoms occur. Option D is incorrect because sucralfate should not be taken with milk, as it can interfere with its effectiveness.
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A client who has a new diagnosis of type 2 diabetes mellitus is being taught about foot care by a nurse. Which of the following statements should the nurse include?
- A. Use lotion on your feet to prevent dry, cracked skin, avoiding application between the toes.
- B. Avoid soaking your feet in warm water daily to prevent dry skin.
- C. Trim your toenails straight across to prevent injury.
- D. Do not apply a heating pad to your feet if they feel cold.
Correct Answer: C
Rationale: The correct answer is C. Trimming toenails straight across is essential for clients with diabetes to prevent the risk of ingrown toenails and injury. Using lotion on feet can be beneficial but should not be applied between the toes to avoid moisture buildup, which can lead to infections. Soaking feet in warm water can lead to dry skin, increasing the risk of cracks and other complications. Applying a heating pad to feet when they feel cold is not recommended for clients with diabetes due to impaired sensation, which can result in burns and other injuries.
A client has a chest tube connected to a water-seal drainage system. Which of the following actions should be taken?
- A. Clamp the chest tube during ambulation
- B. Keep the collection chamber below the level of the chest
- C. Add sterile water to the water-seal chamber
- D. Empty the collection chamber every 12 hours
Correct Answer: C
Rationale: The correct action for the nurse to take when caring for a client with a chest tube connected to a water-seal drainage system is to add sterile water to the water-seal chamber. This is necessary to maintain the correct water level for proper chest tube function. Clamping the chest tube during ambulation (Choice A) is incorrect as it can lead to complications by obstructing drainage. Keeping the collection chamber below the level of the chest (Choice B) is incorrect because it should be kept below the chest to facilitate drainage. Emptying the collection chamber every 12 hours (Choice D) is incorrect as it should be emptied whenever it reaches the fill line or as per facility policy, not on a fixed time schedule.
A healthcare professional is reviewing the medication history of a client who has a new prescription for warfarin. Which of the following medications should the healthcare professional identify as a contraindication for this client?
- A. Acetaminophen
- B. Ibuprofen
- C. Clopidogrel
- D. Metoprolol
Correct Answer: C
Rationale: The correct answer is C, Clopidogrel. Clopidogrel is an antiplatelet medication that increases the risk of bleeding when taken with warfarin. Acetaminophen (choice A) and metoprolol (choice D) do not have significant interactions with warfarin. Ibuprofen (choice B) is an NSAID that can also increase the risk of bleeding when taken with warfarin, but clopidogrel is a more significant contraindication due to its antiplatelet effects. Therefore, healthcare professionals should be cautious when combining warfarin with clopidogrel due to the increased risk of bleeding compared to other options.
A client with heart failure is receiving a continuous IV infusion of milrinone. Which of the following actions should the nurse take?
- A. Monitor the client's blood pressure continuously
- B. Weigh the client daily
- C. Monitor the infusion site for signs of infiltration
- D. Measure the client's intake and output every 2 hours
Correct Answer: D
Rationale: Measuring the client's intake and output every 2 hours is essential when caring for a client receiving a continuous IV infusion of milrinone. Milrinone is a medication that affects fluid balance, and monitoring intake and output helps assess the client's response to the medication. Continuous monitoring of blood pressure may not be necessary unless there is a specific indication. While weighing the client daily is important for overall assessment, measuring intake and output more frequently provides more real-time data for fluid balance evaluation. Monitoring the infusion site is crucial for detecting infiltration but is not directly related to managing fluid balance in this situation.
A nurse is caring for a client who has experienced a stroke and has aphasia. Which of the following communication strategies should the nurse use?
- A. Speak louder to help the client understand
- B. Speak using simple sentences and gestures
- C. Use a picture board to facilitate communication
- D. Have the client practice writing words down
Correct Answer: C
Rationale: The correct answer is to use a picture board to facilitate communication. Aphasia can make it challenging for individuals to understand and use language. Using a picture board can help the client convey their needs and understand information more effectively. Speaking louder (A) may not be helpful as aphasia is not related to hearing loss. While speaking using simple sentences and gestures (B) can be beneficial, using a picture board (C) is a more concrete and visual method to support communication for individuals with aphasia. Having the client practice writing words down (D) may not be suitable if the client's expressive language skills are impaired due to aphasia.