Nokea
A client with rheumatoid arthritis is prescribed methotrexate. Which laboratory value should the nurse monitor?
- A. White blood cell count
- B. Serum creatinine
- C. Blood glucose
- D. Serum potassium
Correct Answer: A
Rationale: For methotrexate in RA, monitor WBC, not creatinine, glucose, or potassium. This immunosuppressant risks leukopenia infection looms if low. Kidneys matter, but marrow's primary. Leadership watches this imagine fever; it ensures safety, aligning with RA therapy effectively.
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Client's potassium is $7.0 \mathrm{mEq} / \mathrm{dL}$. Which prescription should the nurse administer first?
- A. Calcium gluconate IV
- B. Sodium polystyrene enema
- C. Spironolactone oral
- D. Dextrose 10\% IV
Correct Answer: A
Rationale: With potassium at 7.0 mEq/dL, calcium gluconate IV goes first, not polystyrene, spironolactone, or dextrose. Hyperkalemia risks arrhythmias calcium stabilizes cardiac membranes fast, buying time. Polystyrene lowers potassium slowly, spironolactone's diuretic, and dextrose needs insulin. Leadership acts here imagine peaked T-waves; calcium prevents arrest, ensuring safety. This reflects nursing's emergency prioritization, aligning with cardiac stability effectively.
A nurse is assisting with the informed consent process for a client who is scheduled for a below-the-knee amputation. The client asks the nurse, 'Why are they making me have this surgery today? I don't understand why they are doing this.' Which of the following actions should the nurse take?
- A. Explain the procedure in detail
- B. Notify the provider of the client's comments
- C. Reassure the client it's necessary
- D. Have the client sign the consent form
Correct Answer: B
Rationale: Informed consent hinges on the client's full understanding of the procedure, risks, and reasons, which the provider must ensure. When a client expresses confusion, as here with questions about the surgery's necessity, the nurse's role is to facilitate clarity by notifying the provider, who is responsible for explaining and obtaining consent. This action ensures the client receives accurate, authoritative answers, upholding autonomy and legal standards. Explaining the procedure herself exceeds the nurse's scope in this context, risking misinformation. Reassuring without addressing confusion dismisses the client's need for understanding, while forcing a signature without comprehension invalidates consent. Notifying the provider ensures the client's questions are resolved, protecting their rights and ensuring the process remains ethical and informed.
He likewise stresses the need for all the employees to follow orders and instructions from him and not from anyone else. Which of the following principles does he refer to?
- A. Scalar chain
- B. Discipline
- C. Unity of command
- D. Order
Correct Answer: C
Rationale: Unity of command, per Fayol, ensures employees follow one superior Joey avoiding confusion from multiple directives. Scalar chain is the authority line, discipline obedience, and order placement. In his unit, this clarity prevents conflicting orders, like on patient protocols, streamlining care. Joey's leadership enforces this to maintain control, critical in a tertiary hospital where precision impacts outcomes, aligning staff under his vision for efficiency and accountability.
An RN and a licensed practical nurse (LPN) are caring for a client who has a small bowel obstruction and is NPO with a nasogastric (NG) tube set to continuous suction. Which of the following tasks should the RN perform?
- A. Administer IV fluids
- B. Assess for bowel sounds every 2 hours
- C. Monitor NG tube output
- D. Reposition the NG tube
Correct Answer: B
Rationale: The RN's scope of practice includes assessments requiring clinical judgment, such as evaluating bowel sounds to determine hypoactive, normal, or hyperactive states, which informs the care plan for a small bowel obstruction. This task demands interpretive skills beyond the LPN's role, which focuses on data collection (e.g., listening for sounds) rather than analysis. Administering IV fluids, monitoring NG tube output, and repositioning the tube are within the LPN's capabilities under RN supervision, as they involve technical execution rather than diagnostic reasoning. The RN's expertise ensures accurate assessment of bowel function, critical for detecting complications like perforation or resolution of the obstruction, guiding subsequent interventions, and maintaining client safety in a condition requiring precise monitoring and decision-making.
The nurse is preparing to administer a dose of gentamicin to a client with a wound infection. Which laboratory value should the nurse review prior to administration?
- A. Serum creatinine
- B. White blood cell count
- C. Blood glucose
- D. Potassium
Correct Answer: A
Rationale: Before gentamicin for infection, review serum creatinine, not WBC, glucose, or potassium. Aminoglycosides are nephrotoxic creatinine flags kidney function, guiding dosing. Others track infection or unrelated issues. Leadership checks this imagine renal strain; it prevents toxicity, aligning with antibiotic care effectively.