Nokea
A client with tuberculosis has an order for Rifadin (rifampin). What vitamin is usually given with rifampin?
- A. Thiamine
- B. Pyridoxine
- C. Folic acid
- D. Cyanocobalamin
Correct Answer: B
Rationale: Pyridoxine (vitamin B6) is given with rifampin to prevent peripheral neuropathy, a side effect. Other vitamins are not typically associated with rifampin therapy.
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The physician has ordered an irrigation of the client's left ear for the removal of cerumen. To prevent vestibular stimulation, the fluid should be degrees Fahrenheit:
- A. 68
- B. 76
- C. 98
- D. 120
Correct Answer: C
Rationale: Cerumen is removed using a mixture of water and hydrogen peroxide at body temperature. Answers A and B are incorrect because they are too cold. Answer D is incorrect because it is too hot.
The nurse is reinforcing discharge teaching on a client with polycythemia vera. Which would be included in the teaching plan?
- A. Avoid large crowds.
- B. Keep the head of the bed elevated at night.
- C. Wear socks and gloves when going outside.
- D. Know the signs and symptoms of thrombosis.
Correct Answer: D
Rationale: Polycythemia vera increases blood viscosity, raising the risk of thrombosis. Teaching the client to recognize signs and symptoms of thrombosis, such as swelling or pain in extremities, is critical. Avoiding large crowds relates to infection risk, not thrombosis. Elevating the head of the bed is unrelated, and wearing socks and gloves is more relevant for conditions like Raynaud's.
Which of the following medications would be least helpful for a client who is experiencing an acute attack of bronchial asthma?
- A. Cromolyn Sodium (Intal)
- B. Epinephrine (Epi-Pen)
- C. Metaproterenol (Alupent)
- D. Theophylline (Theolair)
Correct Answer: A
Rationale: Cromolyn sodium prevents asthma attacks but is not effective for acute attacks. Epinephrine, metaproterenol, and theophylline provide rapid bronchodilation.
A client was re-admitted to the hospital following a recent skull fracture. Which finding requires the nurse's immediate attention?
- A. Lethargy
- B. Agitation
- C. Ataxia
- D. Hearing loss
Correct Answer: A
Rationale: Lethargy. The level of consciousness or responsiveness is the most important measure of the client's rising intracranial pressure, requiring immediate attention.
A client with renal failure has an order for erythropoietin (Epogen) to be given subcutaneously. The nurse should teach the client to report:
- A. Severe headache
- B. Slight nausea
- C. Decreased urination
- D. Itching
Correct Answer: A
Rationale: Erythropoietin can increase blood viscosity, raising the risk of hypertension or thrombosis, which may present as a severe headache. Slight nausea , decreased urination , and itching are less specific or urgent.