Nokea
A nurse is caring for a client who has chronic renal failure and is receiving epoetin alfa. To check for therapeutic effects, the nurse should monitor which of the following client laboratory tests?
- A. Hemoglobin levels
- B. Iron levels
- C. Platelet count
- D. White blood cell count
Correct Answer: A
Rationale: The correct answer is A: Hemoglobin levels. Epoetin alfa stimulates red blood cell production, increasing hemoglobin levels in clients with chronic renal failure who often have anemia. Monitoring hemoglobin levels helps assess the effectiveness of the medication. Iron levels (B) are important for erythropoiesis but not directly affected by epoetin alfa. Platelet count (C) and white blood cell count (D) are not specifically related to the therapeutic effects of epoetin alfa in chronic renal failure.
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A nurse is reinforcing teaching with a newly licensed nurse about monitoring morphine patient-controlled analgesia (PCA). Which of the following information should the nurse include?
- A. Instruct the client's visitors not to operate the PCA pump.'
- B. Check the client's pain level every 8 hours.'
- C. Diarrhea is an adverse effect of morphine PCA.'
- D. Using morphine PCA increases the client's risk of toxicity.'
Correct Answer: A
Rationale: The correct answer is A, instruct the client's visitors not to operate the PCA pump. This is important to prevent unauthorized administration of medication by individuals who are not trained to use the PCA pump, ensuring patient safety. Checking the client's pain level every 8 hours (B) is important but not the priority in monitoring PCA. Diarrhea is not a common adverse effect of morphine PCA (C), and using morphine PCA does not inherently increase the client's risk of toxicity (D) if used appropriately.
A nurse in a clinic is preparing to administer the measles, mumps, rubella (MMR) vaccine to a client. Which of the following findings should indicate to the nurse that the client has a contraindication for the MMR vaccine?
- A. The client had a local reaction from a previous immunization
- B. The client reports having diarrhea this morning
- C. The client is at 9 weeks of gestation
- D. The client reports an allergy to penicillin.
Correct Answer: C
Rationale: The correct answer is C: The client is at 9 weeks of gestation. Administering the MMR vaccine during pregnancy is contraindicated due to the theoretical risk of causing harm to the fetus. The live attenuated MMR vaccine should not be given to pregnant women as it may potentially harm the developing fetus. It is crucial to avoid administration during pregnancy to prevent any adverse effects on the unborn child.
Other options are incorrect because:
A: The client had a local reaction from a previous immunization - Local reactions to previous vaccines are not contraindications to receiving the MMR vaccine.
B: The client reports having diarrhea this morning - Diarrhea is not a contraindication for the MMR vaccine.
D: The client reports an allergy to penicillin - Allergy to penicillin is not a contraindication for the MMR vaccine.
A nurse is caring for a client who is receiving a continuous IV infusion and reports pain at the IV insertion site. The nurse observes the arm is swollen and cool to touch. After discontinuing the infusion, which of the following actions should the nurse take next?
- A. Restart the infusion in other extremity
- B. Elevate the extremity
- C. Remove the catheter
- D. Apply warm, moist compresses to the site.
Correct Answer: B
Rationale: The correct answer is B: Elevate the extremity. By elevating the extremity, the nurse can help reduce swelling and improve blood flow to the area. This can help alleviate pain and prevent further complications. Removing the catheter (choice C) is necessary but not the immediate next step. Restarting the infusion in another extremity (choice A) can exacerbate the issue. Applying warm, moist compresses (choice D) may not be appropriate if there is swelling. Make sure to monitor the client for any signs of infection or other complications.
A nurse is preparing to insert a miconazole vaginal suppository for a client who has vulvovaginal candidiasis. Which of the following actions is appropriate for inserting this medication?
- A. Assist the client to a left lateral position.
- B. Insert the suppository along the posterior wall of the vaginal canal
- C. Apply a light coating of petroleum jelly to the suppository.
- D. Put on sterile gloves before handling the suppository.
Correct Answer: B
Rationale: The correct answer is B: Insert the suppository along the posterior wall of the vaginal canal. This is because the posterior wall of the vaginal canal allows for the suppository to be placed in the most effective location for absorption and treatment of the infection. Placing it along this wall ensures proper placement and maximum efficacy of the medication.
Choice A: Assisting the client to a left lateral position is not directly related to the correct technique for inserting the suppository.
Choice C: Applying petroleum jelly to the suppository is not necessary and may interfere with the medication's absorption.
Choice D: Putting on sterile gloves before handling the suppository is not required for this procedure as the suppository is meant to be inserted directly into the vaginal canal.
A nurse is preparing to administer phenobarbital 3 mg/kg/day PO in two divided doses to a client who weighs 145 lb. The amount available is phenobarbital 100 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 1
Rationale: To determine the total daily dose, convert the client's weight from lb to kg (145 lb / 2.2 = 65.91 kg). Then calculate the total daily dose in mg (3 mg/kg/day * 65.91 kg = 197.73 mg/day). Since it is divided into two doses, the nurse should administer approximately 99 mg per dose. Since each tablet is 100 mg, the nurse should administer 1 tablet per dose. This is the correct answer, as it ensures the client receives the prescribed dose. Other choices are incorrect as they do not align with the calculated dose needed, leading to potential under or overdosing.