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A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply.
- A. Atorvastatin
- B. Metformin
- C. Metoprolol
- D. Olanzapine
- E. Omeprazole
Correct Answer: C,D
Rationale: Metoprolol, a beta-blocker, can cause orthostatic hypotension, leading to dizziness on standing. Olanzapine, an antipsychotic, is associated with orthostatic hypotension as a side effect. A, B, and E are not commonly linked to orthostatic symptoms; atorvastatin manages cholesterol, metformin controls blood sugar, and omeprazole reduces stomach acid.
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An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently?
- A. Apical heart rate is 62/min
- B. Blood sugar level is 240 mg/dL (13.3 mmol/L)
- C. Client is taking 20 mg fluoxetine daily
- D. Serum creatinine is 2.3 mg/dL (203 µmol/L)
Correct Answer: D
Rationale: Elevated serum creatinine (2.3 mg/dL) indicates renal impairment, which can lead to digoxin accumulation, necessitating frequent monitoring.
The nurse is reinforcing discharge instructions for a postoperative client who had a partial laryngectomy for laryngeal cancer. The client is concerned because the health care provider said there was damage to the ninth cranial nerve. Which statement made by the nurse is most appropriate?
- A. I will ask the health care provider to explain the consequences of your procedure.
- B. This is a common complication that will require you to have a hearing test every year.
- C. This is a common complication; your health care provider will order a consult for the speech pathologist.
- D. This is the reason you are using a special swallowing technique when you eat and drink.
Correct Answer: D
Rationale: The ninth cranial nerve (glossopharyngeal) is involved in swallowing; damage explains the need for special swallowing techniques, directly addressing the client's concern. A avoids providing information. B is incorrect, as the ninth cranial nerve is not related to hearing. C assumes a speech pathology consult, which may not be relevant to swallowing issues caused by nerve damage.
The nurse is auscultating an elderly bedridden client's breath sounds and hears crackles. What is the best interpretation of this finding?
- A. This is normal for the client's age.
- B. This is suggestive of an immediately life-threatening condition.
- C. This is an indication that the client needs to take deep breaths.
- D. This is an indication that the client may need nasal oxygen.
Correct Answer: C
Rationale: Crackles in a bedridden elderly client suggest fluid in the lungs or atelectasis, which deep breathing can help clear. It's not normal, not immediately life-threatening, and oxygen is premature without further assessment.
The nurse is calculating the intake and output for a client who had a transurethral prostatectomy and is receiving continuous bladder irrigation at 175 mL/hr. The nurse empties 2300 mL of urine from the urinary drainage bag at the end of the 8-hour shift. How many mL should the nurse document as the client's net urine output for the shift? Record your answer using a whole number.
- A. 900 mL
Correct Answer: A
Rationale: Irrigation input = 175 mL/hr × 8 hr = 1400 mL. Total output = 2300 mL. Net urine output = 2300 mL - 1400 mL = 900 mL.
The nurse has attended a staff education program about medication administration during pregnancy. Which of the following medications should the nurse recognize are contraindicated during pregnancy? Select all that apply.
- A. lisinopril
- B. albuterol
- C. isotretinoin
- D. doxycycline
- E. levothyroxine
Correct Answer: A,C,D
Rationale: Lisinopril (teratogenic), isotretinoin (severe birth defects), and doxycycline (fetal bone/teeth damage) are contraindicated. Albuterol and levothyroxine are generally safe.