Nokea
A client with a history of chronic obstructive pulmonary disease (COPD) is prescribed tiotropium (Spiriva). The nurse should instruct the client to:
- A. Use the inhaler as needed for shortness of breath.
- B. Rinse the mouth after inhalation.
- C. Take the inhaler with meals.
- D. Stop the inhaler if dizziness occurs.
Correct Answer: B
Rationale: Rinsing the mouth after tiotropium inhalation prevents oral thrush.
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A client's laboratory test results reveal a decrease in both serum transferrin and total iron-binding capacity (TIBC). Which disorder is the most likely cause of the client's anemia?
- A. Infection
- B. Malnutrition
- C. Iron deficiency
- D. Sickle cell disease
Correct Answer: B
Rationale: Malnutrition can cause reductions in the serum transferrin and the TIBC. Infection is an unrelated option. Iron-deficiency anemia is usually characterized by decreased iron-binding capacity but increased transferrin levels. Additionally, in clinical practice, the hemoglobin level is routinely used to detect iron-deficiency anemia. Sickle cell anemia is diagnosed by determining that the client has hemoglobin S.
A primiparous client at 48 hours postpartum is to be given medroxyprogesterone acetate (Depo-Provera) before discharge. Which of the following should the nurse include in the teaching plan before administering this medication?
- A. There is an increased risk of ovarian cancer with use of this drug.
- B. Amenorrhea is common during the first 6 months.
- C. Heavy menstrual bleeding may occur.
- D. The client may experience periods of increased energy.
Correct Answer: B
Rationale: Amenorrhea is a common side effect of Depo-Provera, especially in the first 6 months, and should be included in client teaching. The other options are incorrect.
The nurse notes that the primary health care provider has written a prescription for prednisone for a client. The nurse contacts the primary health care provider about revision of the client's medication plan if which medication is noted on the client's medication record?
- A. Furosemide
- B. Oxycodone
- C. Acetaminophen
- D. Acetylsalicylic acid
Correct Answer: D
Rationale: Prednisone, a glucocorticoid, is irritating to the gastrointestinal (GI) tract, which could be worsened by the use of other products that have the same side effect. Therefore, products such as aspirin (acetylsalicylic acid) and nonsteroidal antiinflammatory drugs are not used during corticosteroid therapy.
A client tells the nurse that he is going to harm his brother-in-law, who called the police on him for threatening to hurt his ex-wife. The nurse should notify which of the following persons? Select all that apply.
- A. Agency administrators.
- B. Ex-wife.
- C. Police.
- D. Intended victim.
- E. Social service department.
Correct Answer: C,D
Rationale: The nurse has a duty to warn the intended victim (brother-in-law) and notify the police due to the credible threat of harm. Notifying administrators or social services may be secondary, and the ex-wife is not the current target.
The nurse is discharging a client who has been hospitalized for preterm labor. The client needs further instruction when she says:
- A. If I think I have a bladder infection, I need to see my obstetrician.'
- B. If I have contractions, I should contact my health care provider.'
- C. Drinking water may help prevent early labor for me.'
- D. If I travel on long trips, I need to get out of the car every 4 hours.'
Correct Answer: D
Rationale: Clients with preterm labor should get out of the car every 1-2 hours to promote circulation and prevent complications, not every 4 hours, indicating a need for further instruction.