A client with chronic obstructive pulmonary disease (COPD) is receiving prednisone (Deltasone). Which side effect should the nurse monitor for?
- A. Hypoglycemia
- B. Infection
- C. Hypotension
- D. Weight loss
Correct Answer: B
Rationale: The correct answer is B: Infection. Prednisone is a corticosteroid that suppresses the immune system, increasing the risk of infections in patients. The nurse should monitor for signs of infection such as fever, increased white blood cell count, and localized symptoms.
Rationale:
A: Hypoglycemia is not a common side effect of prednisone. Prednisone typically causes hyperglycemia.
C: Hypotension is not a common side effect of prednisone. Prednisone can actually cause fluid retention and increased blood pressure.
D: Weight loss is not a common side effect of prednisone. Prednisone can actually cause weight gain due to fluid retention and increased appetite.
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When should surgical correction of hypospadias typically occur for a newborn infant as advised by the nurse?
- A. Repair should be done within one month to prevent bladder infections.
- B. Repairs should typically be done before the child is potty-trained.
- C. Delaying the repair until school age reduces castration fears.
- D. To form a proper urethra repair, it should be done after sexual maturity.
Correct Answer: B
Rationale: The correct answer is B because surgical correction of hypospadias is typically recommended before the child is potty-trained. This is important for optimal cosmetic and functional outcomes, as the procedure is more straightforward in infants due to their smaller anatomy. Delaying the surgery can lead to increased risk of complications and potential psychological impact on the child as they grow older.
A: Repair within one month to prevent bladder infections is not the primary reason for early correction of hypospadias.
C: Delaying the repair to school age for reducing castration fears is not a valid reason for postponing the surgery.
D: Waiting until after sexual maturity to form a proper urethra repair is not recommended as early correction typically yields better results.
While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth on the client's legs. What additional assessment provides further data to support this finding?
- A. Palpate for the presence of femoral pulses bilaterally.
- B. Assess for the presence of a positive Homan's sign.
- C. Observe the appearance of the skin on the client's legs.
- D. Watch the client's posture and balance during ambulation.
Correct Answer: C
Rationale: The correct answer is C: Observe the appearance of the skin on the client's legs. In clients with diabetes mellitus, poor circulation can lead to decreased hair growth on the legs. By observing the skin appearance, the nurse can look for signs of poor circulation such as dry skin, thinning of the skin, or discoloration. This assessment provides further data to support the finding of absent hair growth.
Choices A, B, and D are incorrect because they do not directly relate to the assessment of absent hair growth in clients with diabetes mellitus. Palpating for femoral pulses assesses circulation but does not specifically address the absence of hair growth. Assessing for Homan's sign evaluates for deep vein thrombosis, which is not directly related to hair growth. Watching posture and balance during ambulation assesses mobility and stability but does not provide information on hair growth or circulation in the legs.
A client with heart failure is receiving intravenous furosemide (Lasix). Which assessment finding indicates that the medication is having the desired effect?
- A. Decreased peripheral edema.
- B. Elevated blood pressure.
- C. Increased heart rate.
- D. Decreased urine output.
Correct Answer: A
Rationale: The correct answer is A: Decreased peripheral edema. Furosemide is a diuretic that helps to remove excess fluid from the body, which can reduce peripheral edema in patients with heart failure. This indicates that the medication is effectively reducing fluid overload in the body. Elevated blood pressure (choice B) would not be an expected outcome of furosemide use. Increased heart rate (choice C) is not a direct effect of furosemide and can indicate worsening heart failure. Decreased urine output (choice D) would be an adverse effect of furosemide and would indicate the medication is not working as intended.
A patient with schizophrenia is prescribed olanzapine. What is an important side effect for the healthcare provider to monitor?
- A. Hypertension
- B. Weight gain
- C. Hypoglycemia
- D. Bradycardia
Correct Answer: B
Rationale: The correct answer is B: Weight gain. Olanzapine is known to cause metabolic side effects, including weight gain. This is important to monitor as it can lead to various health issues such as diabetes and cardiovascular problems. Hypertension (A), hypoglycemia (C), and bradycardia (D) are not commonly associated with olanzapine use, making them less likely side effects to monitor in this case.
A client is being discharged with a new prescription for enoxaparin (Lovenox). Which instruction should the nurse include?
- A. Administer the injection in your thigh.
- B. Do not expel the air bubble from the syringe before injection.
- C. Massage the injection site after administration.
- D. Alternate the injection site between the arms.
Correct Answer: B
Rationale: The correct answer is B because expelling the air bubble from the syringe before injection helps ensure accurate dosage delivery and prevents air from being injected into the patient. Administering the injection in the thigh (A) is incorrect as enoxaparin is typically given in the abdomen. Massaging the injection site (C) can cause bruising or hematoma formation. Alternating injection sites between arms (D) is not relevant as enoxaparin is usually given in the abdomen.