Nokea
A client with a history of stroke is prescribed warfarin. The nurse should monitor for which potential side effect?
- A. Bleeding
- B. Weight gain
- C. Headache
- D. Dizziness
Correct Answer: A
Rationale: The correct answer is A: Bleeding. Warfarin is an anticoagulant medication that works by thinning the blood. One of the potential side effects of warfarin is an increased risk of bleeding. It is crucial for the nurse to monitor the client for signs of bleeding, such as unusual bruising, blood in the urine or stool, or prolonged bleeding from cuts or gums. Prompt recognition and management of bleeding are essential to prevent complications.
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A practical nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. Which symptom indicates that the client may be experiencing theophylline toxicity?
- A. Bradycardia
- B. Tremors
- C. Constipation
- D. Hypotension
Correct Answer: B
Rationale: Tremors are a common symptom of theophylline toxicity. Other symptoms that may indicate theophylline toxicity include nausea, vomiting, and seizures. It is important for the nurse to monitor the client closely for these signs of toxicity and report them promptly to the healthcare provider to prevent further complications.
The practical nurse administered 15 units of NPH insulin subcutaneously to a client before they consumed their breakfast at 7:30 AM. At what time is the client at an increased risk for a hypoglycemic reaction?
- A. 8:30 to 11:30 AM
- B. 3:30 to 7:30 PM
- C. 9:30 PM to midnight
- D. 1:00 to 5:00 AM
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client is prescribed atorvastatin. The practical nurse (PN) should monitor the client for which potential adverse effect?
- A. Muscle pain and weakness
- B. Headache
- C. Hepatotoxicity
- D. Gastrointestinal bleeding
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. What action should the nurse take?
- A. Explain that the medication may take time to show improvement in symptoms
- B. Withhold the medication and notify the healthcare provider
- C. Advise the client to undergo liver function tests
- D. Document the assessment findings in the electronic health record
Correct Answer: D
Rationale: In this scenario, the nurse's priority is to document the assessment findings in the electronic health record. This action is crucial for maintaining an accurate record of the client's health status and can provide valuable information for the healthcare team. Withholding medication or advising additional tests should only be done after consulting with the healthcare provider based on the documented assessment findings.
A client with a history of atrial fibrillation is prescribed apixaban. The nurse should monitor for which potential side effect?
- A. Bleeding
- B. Weight gain
- C. Headache
- D. Nausea
Correct Answer: A
Rationale: The correct answer is A: Bleeding. Apixaban is an anticoagulant medication that works by decreasing the blood's ability to clot. One of the significant side effects of apixaban is an increased risk of bleeding. Therefore, the nurse should monitor the client for signs of bleeding, such as easy bruising, prolonged bleeding from cuts, blood in the urine or stool, or unusual bleeding or bruising. Monitoring for these signs is crucial to prevent or manage any potential complications associated with the medication.