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A client reports for a scheduled electroencephalogram (EEG). Which statement by the client indicates a need for additional preparation for the test?
- A. I didn't shampoo my hair.
- B. I ate breakfast this morning.
- C. I didn't take my anticonvulsant today.
- D. It was hard not to drink coffee this morning, but I knew that I couldn't, so I didn't.
Correct Answer: A
Rationale: The correct answer is A. For an EEG, it is essential that the client's hair is clean, without any products like hairspray or gel, to ensure good electrode contact with the scalp. Choice B is not a concern as having breakfast is allowed before the test. Choice C, not taking an anticonvulsant, might be required for certain types of EEGs to capture accurate brain activity. Choice D, not drinking coffee, is not a specific requirement for an EEG preparation.
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The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?
- A. My sodium level changes due to the movement from the blood into the dialysate.
- B. Dialysis works by the movement of wastes from higher to lower concentration.
- C. Extra fluid can be pulled from the blood by osmosis.
- D. The dialysate is similar to blood but without any toxins.
Correct Answer: B
Rationale: The correct answer is B because dialysis works by the movement of solutes from an area of higher concentration to an area of lower concentration, which is known as diffusion. The other statements are accurate: A correctly describes the movement of sodium during hemodialysis, C explains the removal of excess fluid by osmosis, and D highlights the purpose of the dialysate in removing toxins from the blood.
A young female client prescribed amoxicillin (Amoxil) for a urinary tract infection is being taught by a nurse. Which statement should the nurse include in this client's teaching?
- A. Use a second form of birth control while taking this medication.
- B. You will experience increased menstrual bleeding while on this medication.
- C. You may experience an irregular heartbeat while on this medication.
- D. Watch for blood in your urine while taking this drug.
Correct Answer: A
Rationale: The correct statement for the nurse to include in the teaching is to advise the client to use a second form of birth control while taking amoxicillin. Penicillin, like amoxicillin, may reduce the effectiveness of estrogen-containing contraceptives, making it important to use additional contraceptive measures. The incorrect choices are B, C, and D. Increased menstrual bleeding, irregular heartbeat, or blood in the urine are not common side effects associated with amoxicillin use for a urinary tract infection.
A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for
- A. hyperkalemia.
- B. hypermagnesemia.
- C. hypocalcemia.
- D. hypoglycemia.
Correct Answer: A
Rationale: The correct answer is A: hyperkalemia. Spironolactone is a potassium-sparing diuretic commonly used in heart failure management. One of the major side effects of spironolactone is hyperkalemia, which is an elevated level of potassium in the blood. Monitoring for hyperkalemia is crucial as it can lead to serious cardiac arrhythmias. Choices B, C, and D are incorrect. Hypermagnesemia (choice B) is not typically associated with spironolactone use. Hypocalcemia (choice C) and hypoglycemia (choice D) are also not directly linked to the use of spironolactone in heart failure treatment.
Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for a hospitalized client scheduled for a colonoscopy. The client begins to experience diarrhea after drinking the solution. Which action by the nurse is appropriate?
- A. Calling the physician
- B. Administering a cleansing enema
- C. Documenting the diarrhea in the medical record
- D. Giving intravenous replacement fluids in large amounts
Correct Answer: C
Rationale: The correct action by the nurse in this situation is to document the diarrhea in the medical record. Polyethylene glycol-electrolyte solution (GoLYTELY) is a bowel evacuant used to cleanse the bowel before a colonoscopy. It is expected to cause mild diarrhea, which is a normal response to the medication. The diarrhea helps clear the bowel in preparation for the procedure. Calling the physician is not necessary unless there are complications. Administering a cleansing enema or giving intravenous replacement fluids in large amounts are not appropriate actions as they are not indicated for managing the expected diarrhea caused by GoLYTELY.
A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?
- A. Disorientation and dyspnea
- B. Drowsiness, headache, and tachypnea
- C. Tachypnea, dizziness, and paresthesias
- D. Dysrhythmias and decreased respiratory rate and depth
Correct Answer: D
Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.