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A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks why, the client responds, 'Because I’m not depressed!' What is the nurse’s most appropriate response?
- A. Depression is common with fibromyalgia, but a low dose of this drug can prevent it
- B. It can relieve your chronic pain and help you sleep better at night
- C. It helps to relieve the adverse effects of your other prescribed drugs
- D. You have the right to refuse. I will notify your health care provider (HCP)
Correct Answer: B
Rationale: Duloxetine treats fibromyalgia pain and improves sleep, addressing the client’s misconception without focusing on depression. Other responses are inaccurate or dismissive.
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The nurse is caring for a client who has subclavian central venous access. Which nursing intervention is most important to prevent the spread of infection to this client?
- A. Frequent hand hygiene
- B. No artificial nails
- C. Use of chlorhexidine bath wipes
- D. Wearing personal protective equipment
Correct Answer: A
Rationale: Frequent hand hygiene is the most effective intervention to prevent infection in central venous access, reducing pathogen transmission. No artificial nails and chlorhexidine wipes are supportive, but hand hygiene is primary. PPE is situational.
A 14-year-old client confides to the school nurse that she is pregnant, likely in the second trimester, and has not had prenatal care. Which of the following topics should the nurse discuss with the client at this time? Select all that apply.
- A. Desire for adoption planning services
- B. Emotional response to the pregnancy
- C. Family/social support systems
- D. Nutritional habits and substance use
- E. Plan for finishing high school
Correct Answer: A,B,C,D,E
Rationale: All topics are critical: adoption planning, emotional response, support systems, nutrition/substance use, and education planning address the client’s immediate and long-term needs in a sensitive, holistic manner.
The nurse is caring for several clients who are to have diagnostic tests. Which clients will receive similar instructions?
- A. The client who is having an upper GI series and the client who is having a lower GI series
- B. The client who is having a gallbladder sonogram and the client who is having a gallbladder x-ray
- C. The client who is having a barium enema and the client who is having a colonoscopy.
- D. The client who is having a gastroscopy and the client who is having a colonoscopy.
Correct Answer: C
Rationale: A barium enema and a colonoscopy both require a clear liquid diet and full bowel prep the day before. The only difference is that the client who is having a barium enema can have red liquids and the one who is having a colonoscopy cannot. The preparation for an upper GI series is NPO after midnight the night before. There is no preparation for a gallbladder sonogram. A gallbladder x-ray requires fat restriction the day before, taking iodine dye tablets, and NPO after midnight. The preparation for a gastroscopy is NPO after midnight the night before.
An unlicensed assistive personnel (UAP), who usually works in pediatrics is assigned to work on a medical-surgical unit. Which one of the questions by the charge nurse would be most appropriate prior to making delegation decisions?
- A. How long have you been a UAP?
- B. What type of care did you give in pediatrics?
- C. Do you have your competency checklist that we can review?
- D. How comfortable are you to care for adult clients?
Correct Answer: C
Rationale: The UAP must be competent to accept the delegated task. Further assessment of the qualifications of the UAP is important in order to assign the right task.
The nurse is caring for a client who is very demanding. She frequently rings the bell and asks to have her pillow fluffed or the water glass filled. Which response by the nurse will likely be most effective?
- A. Answer the bell quickly each time she rings
- B. Say, 'I do not have time to be in your room constantly.'
- C. Say, 'Why are you so upset?'
- D. Say, 'You seem concerned about something.'
Correct Answer: D
Rationale: Acknowledging potential underlying concerns invites the client to express needs, reducing demands. Constant responses reinforce behavior, and dismissive or confrontational responses escalate tension.