Nokea
A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse monitors the client for relief of which symptom?
- A. Flatus
- B. Heartburn
- C. Rectal pain
- D. Muscle twitching
Correct Answer: B
Rationale: Calcium carbonate is used as an antacid for the relief of heartburn and indigestion. It can also be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with renal failure. The remaining options are unrelated to this medication.
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The nurse is monitoring a client with a diagnosis of chronic kidney disease (CKD). Which assessment finding should the nurse report to the primary health care provider?
- A. Pallor
- B. Fatigue
- C. Lethargy
- D. Petechiae
Correct Answer: D
Rationale: CKD can cause damage to many body systems. Hematological manifestations that can occur with this disease include anemia and bleeding. Abnormal bleeding (petechiae; purpura; bruising; bleeding from the mucous membranes, nose, or gums; vaginal bleeding; or intestinal bleeding) should be reported to the primary health care provider because it can be life-threatening. Pallor, fatigue, and lethargy are clinical manifestations associated with anemia.
The nurse caring for a child diagnosed with a patent ductus arteriosus should base planning on which fact concerning this disorder?
- A. It involves an opening between the two atria.
- B. It produces abnormalities in the atrial septum.
- C. It involves an opening between the two ventricles.
- D. It involves an artery that connects the aorta and the pulmonary artery.
Correct Answer: D
Rationale: Patent ductus arteriosus is described as an artery that connects the aorta and the pulmonary artery during fetal life. It generally closes spontaneously within a few hours to several days after birth. It allows abnormal blood flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. The remaining options are not characteristics of this cardiac defect.
A college student is asking the nurse about his grandfather, who just received a diagnosis of Huntington's disease. The student wants to know if he will have the disease, too. What should the nurse tell the student? Select all that apply.
- A. Huntington's disease affects men more than women.'
- B. Huntington's disease is an autosomal dominant disease.'
- C. Huntington's disease does not skip a generation.'
- D. Huntington's disease is a treatable disease.'
- E. There is a 75% chance you will have the disease.'
Correct Answer: B,C
Rationale: Huntington's disease is an autosomal dominant disorder, meaning a 50% chance of inheritance if one parent is affected, and it typically does not skip generations. It affects men and women equally, is not treatable (only symptom management is available), and the risk is not 75% but 50%.
You are caring for an acute care adult client in the medical unit who has no history of a psychiatric mental health disorder. This 76 year old client has suddenly and abruptly started to exhibit episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. The client reports to you that they are seeing clowns in their room. This client is dehydrated and has just begun taking an anticholinergic medication. Which of the following is the most appropriate nursing diagnosis for this client?
- A. Psychotic symptoms related to sensory overload
- B. Psychotic symptoms related to a previously undiagnosed psychosis
- C. Visual disturbances related to dementia
- D. Visual disturbances related to delirium
Correct Answer: D
Rationale: The sudden onset of impaired cognition, fluctuating mental status, and visual hallucinations in the context of dehydration and anticholinergic medication use strongly suggests delirium, not dementia or psychosis.
A client with a history of peptic ulcer disease is prescribed misoprostol (Cytotec). The nurse should instruct the client to:
- A. Take the medication with meals.
- B. Avoid antacids.
- C. Take the medication at bedtime.
- D. Stop the medication if diarrhea occurs.
Correct Answer: A
Rationale: Misoprostol should be taken with meals to reduce gastrointestinal upset and protect the stomach lining.