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A client with Parkinson's disease is prescribed levodopa/carbidopa. The nurse instructs the client to take the medication with meals. Which rationale should the nurse provide for taking the medication with food?
- A. It enhances the effectiveness of the medication
- B. It helps to improve absorption
- C. It prevents orthostatic hypotension
- D. It reduces gastrointestinal upset
Correct Answer: D
Rationale: The correct answer is D: 'It reduces gastrointestinal upset.' Levodopa/carbidopa can cause nausea and other gastrointestinal side effects. Taking the medication with food can help reduce these side effects and improve the client's comfort. Choices A, B, and C are incorrect because taking the medication with food does not primarily enhance effectiveness, improve absorption, or prevent orthostatic hypotension. The main reason for advising to take the medication with meals is to minimize gastrointestinal upset.
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A client is diagnosed with Meniere's disease. Which problem should the nurse identify as most important in the plan of care?
- A. Social isolation related to hearing loss
- B. Risk for injury related to vertigo
- C. Impaired verbal communication
- D. Impaired hearing related to ear disease
Correct Answer: B
Rationale: Vertigo is the primary symptom of Meniere's disease and can lead to falls and other injuries. Ensuring safety and addressing the risk of injury is the nurse's top priority. While social isolation and impaired hearing are significant concerns associated with Meniere's disease, the immediate danger of falls due to vertigo takes precedence in the plan of care. Impaired verbal communication, although important, is not as urgent as preventing injuries caused by vertigo.
Which dietary instruction is most important for a client with renal disease?
- A. Avoid all protein-rich foods.
- B. Limit fluid intake to 1500 ml/day.
- C. Increase potassium intake to prevent weakness.
- D. Eat small, frequent meals high in carbohydrates.
Correct Answer: B
Rationale: The most important dietary instruction for a client with renal disease is to limit fluid intake to 1500 ml/day. This is essential to prevent fluid overload, manage electrolyte balance, and reduce strain on the kidneys. Choice A is incorrect because while protein restriction may be necessary in some cases, avoiding all protein-rich foods is not recommended as some protein intake is essential for overall health. Choice C is incorrect because increasing potassium intake is generally not advised for clients with renal disease, as they often need to limit potassium intake. Choice D is also incorrect because while consuming small, frequent meals may be helpful, emphasizing a diet high in carbohydrates is not typically the primary focus for clients with renal disease.
After placing a stethoscope to auscultate S1 and S2 heart sounds, what should the nurse do to check for an S3 heart sound?
- A. Switch to the diaphragm of the stethoscope to hear any abnormal sounds
- B. Listen with the bell of the stethoscope at the same location
- C. Listen at a different location over the aortic area
- D. Switch to the apical area and reassess for S3 sounds
Correct Answer: B
Rationale: To assess for an S3 heart sound, the nurse should listen with the bell of the stethoscope. An S3 heart sound is often low-pitched and best heard with the bell. Choice A is incorrect because switching to the diaphragm is not ideal for detecting low-pitched sounds like an S3. Choice C is incorrect as the S3 heart sound is best heard over the apex of the heart, not the aortic area. Choice D is incorrect because moving to the apical area is appropriate, but the nurse should specifically use the bell of the stethoscope to listen for S3 sounds.
A client with dyspnea is being admitted to the medical unit. To best prepare for the client's arrival, the nurse should ensure that the client's bed is in which position?
- A. Trendelenburg
- B. Supine
- C. Prone
- D. Fowler's
Correct Answer: D
Rationale: Fowler's position (head elevated at 45-60 degrees) improves oxygenation by expanding the lungs, making it the best position for clients with dyspnea. Supine or prone positions restrict lung expansion, and Trendelenburg position (head down) can exacerbate breathing difficulties by increasing pressure on the lungs and diaphragm.
A client with a history of deep vein thrombosis (DVT) is prescribed warfarin. Which laboratory value should the nurse monitor to assess the therapeutic effect of this medication?
- A. Platelet count
- B. Prothrombin time (PT)
- C. White blood cell count
- D. Hemoglobin level
Correct Answer: B
Rationale: Prothrombin time (PT) is the correct laboratory value to monitor to assess the therapeutic effect of warfarin. Warfarin works by inhibiting clotting factors, and PT measures the time it takes for blood to clot. Monitoring PT helps ensure that the medication is working effectively to prevent clot formation without causing excessive bleeding. Platelet count (Choice A) is not specific to warfarin therapy and assesses the number of platelets in the blood. White blood cell count (Choice C) and hemoglobin level (Choice D) are not directly related to monitoring the therapeutic effect of warfarin.