Nokea
A client with a history of renal calculi is prescribed allopurinol (Zyloprim). The nurse should instruct the client to:
- A. Increase fluid intake.
- B. Avoid dairy products.
- C. Take the medication with meals.
- D. Stop the medication if pain resolves.
Correct Answer: A
Rationale: Increased fluid intake prevents stone formation while taking allopurinol for uric acid stones.
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The nurse is assessing a neonate born to a diabetic mother. Which of the following findings should the nurse expect to see in the infant?
- A. Hypertonia
- B. Hyperactivity
- C. Large size
- D. Scaly skin
Correct Answer: C
Rationale: Neonates born to diabetic mothers are often macrosomic (large size) due to maternal hyperglycemia. Hypertonia, hyperactivity, and scaly skin are not typical findings.
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.
When determining the parents' compliance with treatment for their child's ear infection, the nurse should ask the parents if they are:
- A. Cleaning the child's ear canals with hydrogen peroxide.
- B. Administering continuous, low-dose antibiotic therapy.
- C. Instilling ear drops regularly to prevent cerumen accumulation.
- D. Holding the child upright when feeding with a bottle.
Correct Answer: D
Rationale: Holding the child upright during feeding prevents milk from entering the Eustachian tube, reducing ear infection risk.
The nurse is performing an assessment on a client with a diagnosis of systemic lupus erythematosus (SLE). Which finding should the nurse expect to note? Select all that apply.
- A. Fever
- B. Bradycardia
- C. Lymphadenopathy
- D. Butterfly rash on the face
- E. Muscular aches and pains
Correct Answer: A,C,D,E
Rationale: Manifestations of SLE may include fever, musculoskeletal aches and pains, butterfly rash on the face, pleural effusion, basilar pneumonia, generalized lymphadenopathy, pericarditis, tachycardia, hepatosplenomegaly, nephritis, delirium, seizures, psychosis, and coma.
The nurse is caring for a client who has just undergone a tonsillectomy. Which of the following interventions is most important in the immediate postoperative period?
- A. Encourage frequent swallowing.
- B. Monitor for excessive swallowing.
- C. Offer ice chips immediately.
- D. Keep the head of the bed flat.
Correct Answer: B
Rationale: Monitoring for excessive swallowing is critical post-tonsillectomy, as it may indicate bleeding from the surgical site.