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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 charge nurse is reviewing events that staff nurses experienced during the shift. Which events require an incident/occurrence report to be completed? Select all that apply.
- A. Client determined brain dead was taken off life support
- B. Client with alcohol intoxication physically assaulted a nurse
- C. Serum troponin level was prescribed but never obtained
- D. Staff nurse did not present for work and did not notify management
- E. Visitor fell and refused care in the emergency department
Correct Answer: B,C,D
Rationale: Assault, missed lab tests, and staff no-show are reportable incidents due to safety, care quality, and staffing issues. Brain death withdrawal follows protocol, and a visitor’s fall with refused care is less reportable.
The nurse approaches a 4-year-old boy to administer a medication. The child has no identification armband. Which action is most appropriate?
- A. Check the room and bed number the child is in with the room and bed number on the medication order and administer the medication if they agree
- B. Ask the child what his name is before administering the medication
- C. Ask the child if his name is George (the name on the medication order) and administer the medication if the child says that is his name
- D. Ask the adults at the bedside what the child's name is and administer the medication if the adults verify the name of the child
Correct Answer: D
Rationale: Verifying the child's identity with adults at the bedside ensures safety, as children may not reliably confirm their own identity, and room/bed numbers are not sufficient for identification.
A client is being evaluated for carpal tunnel syndrome. The nurse is observed asking the client to place the backs of her hands together and flex them at the same time. Which assessment is the nurse performing?
- A. Phalen's maneuver
- B. Tinel's sign
- C. Kernig's
- D. Brudzinski's
Correct Answer: A
Rationale: Phalen's maneuver involves flexing the wrists with the backs of the hands together to assess for carpal tunnel syndrome, as it may reproduce symptoms. Tinel's sign involves tapping over the median nerve. Kernig's and Brudzinski's are tests for meningitis, not carpal tunnel syndrome.
A nurse is performing a dressing change for a hospitalized client with an infected surgical incision. Which actions should the nurse take?
- A. Have the client remove the existing dressing while the nurse prepares sterile supplies
- B. Wear clean gloves for removal and application of a new dressing
- C. Wear clean gloves to remove the existing dressing, changing to sterile gloves to apply the new dressing
- D. Wear sterile gloves, gown, and goggles to remove the soiled existing dressing
Correct Answer: C
Rationale: Clean gloves for removing soiled dressings prevent contamination, while sterile gloves for applying the new dressing maintain a sterile field. Full PPE is excessive for removal, and clean gloves for application risk infection.
A 52-year-old woman who has thyroid cancer is treated with radioactive iodine (Iodotope). What should be included in the nursing care plan following administration of the drug? Select all that apply.
- A. Tell the client not to eat or drink anything for four hours.
- B. Tell the client not to sleep in the same room with anyone for seven days following administration.
- C. Save the client's urine in a lead container for 48 hours.
- D. Limit contact with the client to 30 minutes per person per shift on day 1.
- E. Assign client to a single room.
- F. Tell client to report weight gain and severe fatigue to health care provider.
Correct Answer: B,D,E,F
Rationale: Radioactive iodine requires isolation in a single room, limited contact (30 minutes/shift), separate sleeping for 7 days, and reporting symptoms like fatigue or weight gain (hypothyroidism). NPO or urine storage are not standard.