Nokea
A nurse is caring for a client who has a new diagnosis of essential hypertension. The nurse should monitor the client for which of the following findings that is consistent with this diagnosis?
- A. Vertigo
- B. Fatigue
- C. Excessive thirst
- D. Frequent urination
Correct Answer: A
Rationale: The correct answer is A: Vertigo. Essential hypertension can cause vertigo due to increased pressure in the blood vessels supplying the inner ear. Vertigo is a common symptom of hypertension. Fatigue (B) is a non-specific symptom seen in many conditions. Excessive thirst (C) and frequent urination (D) are more indicative of diabetes mellitus rather than essential hypertension.
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A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?
- A. C-reactive protein
- B. Erythrocyte sedimentation rate (ESR)
- C. White blood cell count
- D. Hematocrit
Correct Answer: B
Rationale: The correct answer is B: Erythrocyte sedimentation rate (ESR). ESR is a common test used to monitor inflammation levels in rheumatoid arthritis (RA) patients. Aspirin is an anti-inflammatory medication, so monitoring ESR can help assess the effectiveness of the treatment. A decrease in ESR levels indicates a reduction in inflammation, suggesting that the aspirin is working. The other choices (A, C, D) are not specific to monitoring the effectiveness of aspirin in RA. C-reactive protein and white blood cell count are general markers of inflammation and infection, not specific to RA. Hematocrit measures red blood cell levels, which are not directly related to the effectiveness of aspirin in treating RA.
A nurse is teaching a class about preventive care to clients who are at risk for acquiring viral hepatitis. Which of the following information should the nurse include in the presentation?
- A. Avoid foods prepared with tap water.
- B. Use purified water for drinking.
- C. Limit intake of fried foods.
- D. Get vaccinated for hepatitis C.
Correct Answer: A
Rationale: The correct answer is A: Avoid foods prepared with tap water. Tap water in certain regions may be contaminated with hepatitis-causing viruses. Using bottled or purified water for drinking alone (choice B) may not prevent exposure through food preparation. Limiting fried foods (choice C) is unrelated to preventing viral hepatitis. While getting vaccinated for hepatitis C (choice D) is important, it is not directly related to preventing exposure through contaminated tap water. Therefore, the most effective preventive measure is to avoid foods prepared with tap water to reduce the risk of acquiring viral hepatitis.
A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?
- A. Hyperglycemia
- B. Tachycardia
- C. Hypertension
- D. Bradycardia
Correct Answer: D
Rationale: The correct answer is D: Bradycardia. Atenolol is a beta-blocker that slows down the heart rate, leading to bradycardia as an adverse effect. This occurs because atenolol blocks the action of adrenaline on the heart, causing the heart to beat slower. Hyperglycemia (A) is not a common adverse effect of atenolol; in fact, it may even lower blood sugar levels slightly. Tachycardia (B) and hypertension (C) are the opposite effects of atenolol, as it is used to treat high blood pressure and reduce heart rate. Therefore, these would not be expected adverse effects.
A nurse is collaborating on care for a client who has COPD. Which of the following tasks should the nurse recommend be referred to an occupational therapist for assistance?
- A. Instructing how to use kitchen tools to prepare a meal
- B. Administering oxygen therapy
- C. Monitoring oxygen saturation levels
- D. Assessing breathing patterns
Correct Answer: A
Rationale: The correct answer is A because an occupational therapist can help the client with COPD by providing strategies and adaptive tools for meal preparation to conserve energy and promote independence in daily activities. Administering oxygen therapy (B), monitoring oxygen saturation levels (C), and assessing breathing patterns (D) are within the scope of nursing practice for managing COPD. These tasks require clinical knowledge and skills that nurses are trained to perform.
A nurse in an emergency department is caring for a client who reports substernal chest pain and dyspnea. The client is vomiting and is diaphoretic. Which of the following laboratory tests are used to diagnose a myocardial infarction? (Select all that apply.)
- A. Troponin I, Troponin T, CPK, Myoglobin
- B. Plasma low-density lipoproteins
- C. White blood cell count
- D. Blood glucose level
Correct Answer: A
Rationale: The correct answer is A. Troponin I, Troponin T, CPK, and Myoglobin are all specific laboratory tests used to diagnose a myocardial infarction. Troponin I and T are cardiac biomarkers released into the bloodstream following myocardial cell injury. Creatine phosphokinase (CPK) is an enzyme found in high concentrations in the heart muscle, and elevated levels indicate myocardial damage. Myoglobin is a protein released from damaged muscle cells, including cardiac muscle. These tests provide crucial information to confirm the diagnosis of a myocardial infarction.
Plasma low-density lipoproteins are not specific for diagnosing a myocardial infarction. White blood cell count is not typically used for diagnosing a myocardial infarction, although it may be elevated in response to inflammation associated with heart damage. Blood glucose level is not specific for diagnosing a myocardial infarction and