Nokea
A nurse is caring for a client who has a cloudy, opaque area over the lens of one eye. The nurse should identify that this is a manifestation of which of the following visual impairments?
- A. Cataracts
- B. Diabetic retinopathy
- C. Macular degeneration
- D. Glaucoma
Correct Answer: A
Rationale: The correct answer is A: Cataracts. Cataracts cause a cloudy, opaque area over the lens of the eye, leading to blurred vision. This occurs due to the clouding of the lens from protein buildup. Diabetic retinopathy, choice B, involves damage to blood vessels in the retina due to diabetes. Macular degeneration, choice C, affects the central part of the retina leading to distortion or loss of central vision. Glaucoma, choice D, is characterized by increased pressure within the eye damaging the optic nerve. In this scenario, the cloudy, opaque area over the lens specifically points towards cataracts, making it the correct choice.
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A nurse is preparing to administer furosemide 30 mg IV bolus stat. Available is furosemide injection 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 3
Rationale: To determine the correct mL of furosemide to administer, we can use the formula: Desired dose (30 mg) / Available dose (10 mg/mL) = mL to administer. So, 30 mg / 10 mg/mL = 3 mL. The correct answer is therefore 3 mL.
Choice A: Incorrect. This answer does not provide the correct calculation based on the given information.
Choice B: Incorrect. This answer does not demonstrate the correct calculation based on the given information.
Choice C: Incorrect. This answer does not reflect the accurate calculation using the provided data.
Choice D: Incorrect. This choice does not show the correct calculation based on the information presented.
Choice E: Incorrect. This response does not align with the correct calculation method for determining the mL to administer.
Choice F: Incorrect. This choice does not offer the accurate calculation based on the provided data.
Choice G: Incorrect. This answer does not demonstrate the correct calculation using the
A client is to receive enoxaparin 30 mg subcutaneously. Available is enoxaparin 40 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 0.8
Rationale: The correct answer is 0.8 mL. To determine this, divide the desired dose (30 mg) by the concentration (40 mg/mL) to get 0.75. Since we need to round to the nearest tenth, 0.75 rounds up to 0.8 mL. The other choices are incorrect because: A: 0.7 mL, B: 0.9 mL, C: 0.6 mL, D: 1.0 mL, E: 0.5 mL, F: 1.2 mL, G: 0.3 mL. These choices do not accurately reflect the calculated dose based on the given information.
A nurse is caring for a client who is taking lisinopril (ACE inhibitor). Which of the following outcomes indicates a therapeutic effect of the medication?
- A. Improved sexual function
- B. Decreased blood pressure
- C. Increase of HDL cholesterol
- D. Prevention of bipolar manic episodes
Correct Answer: B
Rationale: The correct answer is B: Decreased blood pressure. Lisinopril is an ACE inhibitor used to treat hypertension by relaxing blood vessels, leading to decreased blood pressure. This outcome is a therapeutic effect because it helps reduce the risk of cardiovascular events. Improved sexual function (A) is not a direct effect of lisinopril. Increase of HDL cholesterol (C) is not a primary effect of ACE inhibitors. Prevention of bipolar manic episodes (D) is unrelated to the mechanism of action of lisinopril.
A nurse is teaching a client about the Rinne test. Which of the following client statements indicates an understanding of the teaching?
- A. I will wear earphones during this test
- B. A small probe is placed inside my ear
- C. A tuning fork is placed on my head
- D. Small electrodes are placed on my scalp
Correct Answer: C
Rationale: The correct answer is C: A tuning fork is placed on my head. In the Rinne test, a tuning fork is first placed against the client's mastoid bone behind the ear and then moved near the ear canal. The client should hear the sound louder when the fork is near the ear if the test is normal. Choice A is incorrect because earphones are not used in the Rinne test. Choice B is incorrect as a probe is not inserted into the ear. Choice D is incorrect as electrodes are not part of the Rinne test. Placing a tuning fork on the head is the correct step in performing the Rinne test to assess hearing conduction.
A nurse is preparing to administer a client's antihypertensive medication. When using clinical judgment, which of the following findings indicates the nurse should further assess the client before administering medication?
- A. The client reports dizziness when ambulating to the bathroom
- B. The client reports having trouble sleeping the previous night
- C. The client ate 60% of their breakfast
- D. The client has a urine output of 400 mL for the past 8 hr
Correct Answer: A
Rationale: The correct answer is A. Dizziness when ambulating can be a sign of orthostatic hypotension, a potential side effect of antihypertensive medication. The nurse should further assess for signs of hypotension before administering the medication. Choices B, C, and D are less relevant to antihypertensive medication administration. Reporting trouble sleeping, eating 60% of breakfast, and having a urine output of 400 mL are not direct contraindications for administering antihypertensive medication.