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A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the client's teaching?
- A. Avoid alcohol while taking this medication.
- B. Take the medication with a full meal.
- C. Increase your intake of high-fiber foods.
- D. Avoid exposure to sunlight.
Correct Answer: A
Rationale: The correct answer is A: Avoid alcohol while taking this medication. Methotrexate can cause liver toxicity, and alcohol consumption can exacerbate this risk. It is important for the client to avoid alcohol to prevent potential harm to the liver.
B: Taking the medication with a full meal is not a necessary instruction for methotrexate. It is typically recommended to take methotrexate on an empty stomach.
C: Increasing intake of high-fiber foods is not directly related to methotrexate therapy. It is important for overall health but not specifically for this medication.
D: Avoiding exposure to sunlight is not a common instruction for methotrexate. While some medications can increase sensitivity to sunlight, this is not a typical concern with methotrexate.
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A client with diabetes has a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that should be prepared in the insulin syringe?
- A. 42 units
- B. 14 units
- C. 28 units
- D. 32 units
Correct Answer: A
Rationale: The correct answer is A: 42 units. To calculate the total number of units of insulin to be prepared in the syringe, you need to add the units of regular insulin (14 units) and NPH insulin (28 units). Therefore, 14 units + 28 units = 42 units. This is the total amount of insulin that should be drawn up and administered subcutaneously.
Summary of other choices:
B: 14 units - This is only the amount of regular insulin and doesn't include the NPH insulin.
C: 28 units - This is only the amount of NPH insulin and doesn't include the regular insulin.
D: 32 units - This is the sum of 14 units of regular insulin and 18 units of NPH insulin, which is incorrect as the NPH insulin prescribed is 28 units, not 18 units.
A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?
- A. Primary biliary cirrhosis
- B. Primary sclerosing cholangitis
- C. Gallstones
- D. Pancreatic cancer
Correct Answer: A
Rationale: The most likely diagnosis is A: Primary biliary cirrhosis. This is supported by the patient's symptoms of fatigue, pruritus, jaundice, elevated bilirubin and alkaline phosphatase levels, and dilated intrahepatic bile ducts. Primary biliary cirrhosis is an autoimmune liver disease that primarily affects middle-aged women, leading to destruction of intrahejson hepatic bile ducts. The normal common bile duct rules out obstruction from gallstones or pancreatic cancer. Primary sclerosing cholangitis typically presents with strictures in the bile ducts, which is not seen in this case. Therefore, the combination of symptoms, lab findings, and imaging results point towards primary biliary cirrhosis as the most likely diagnosis.
What assessments should the nurse prioritize for a client with portal hypertension admitted to the medical floor?
- A. Assessment of blood pressure and evaluation for headaches and visual changes
- B. Assessment for signs and symptoms of venous thromboembolism
- C. Daily weights and measurement of abdominal girth
- D. Monitoring blood glucose every 4 hours
Correct Answer: C
Rationale: The correct answer is C: Daily weights and measurement of abdominal girth. Portal hypertension can lead to fluid retention and ascites, causing weight gain and abdominal distension. Monitoring these parameters helps assess fluid status and effectiveness of treatment.
A: Assessment of blood pressure and evaluation for headaches and visual changes is not a priority as they are not directly related to portal hypertension.
B: Assessment for signs and symptoms of venous thromboembolism is not a priority in this case unless there are specific risk factors present.
D: Monitoring blood glucose every 4 hours is not directly related to portal hypertension and is not a priority in this scenario.
A healthcare provider is providing dietary teaching to a client with cholecystitis. Which type of diet should the healthcare provider recommend?
- A. High-fiber, low-fat diet
- B. Low-fiber, high-protein diet
- C. Low-fat, low-cholesterol diet
- D. High-protein, high-fat diet
Correct Answer: C
Rationale: The correct answer is C: Low-fat, low-cholesterol diet. For cholecystitis, which is inflammation of the gallbladder, a low-fat, low-cholesterol diet is essential to prevent exacerbation of symptoms. High-fat diets can trigger gallbladder attacks, while low-fat and low-cholesterol diets help reduce the workload on the gallbladder. High-fiber (choice A) may be too harsh on the digestive system. Low-fiber, high-protein (choice B) and high-protein, high-fat (choice D) diets can exacerbate symptoms due to the high-fat content.
When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?
- A. Use glycerin suppositories on a regular basis
- B. Limit physical activity in order to promote bowel peristalsis
- C. Consume high-residue, high-fiber foods
- D. Resist the urge to defecate until the urge becomes intense
Correct Answer: C
Rationale: The correct answer is C: Consume high-residue, high-fiber foods. High-fiber foods promote regular bowel movements by adding bulk to the stool, making it easier to pass. Fiber also helps in maintaining bowel health and preventing constipation. Glycerin suppositories (A) should not be used regularly as they can lead to dependence. Limiting physical activity (B) is not recommended as exercise can aid in promoting bowel peristalsis. Resisting the urge to defecate (D) can worsen constipation and lead to complications. In summary, promoting high-fiber diet is the most effective way to help manage chronic constipation.