Nokea
A nurse is caring for a client who is receiving IV fluids with potassium chloride. Which of the following actions should the nurse take?
- A. Monitor the client's cardiac rhythm.
- B. Administer the IV fluids through a large-gauge needle.
- C. Check the client's magnesium levels every 8 hr.
- D. Instruct the client to reduce sodium intake.
Correct Answer: A
Rationale: Potassium chloride can cause arrhythmias, so cardiac monitoring is essential. Needle size varies, magnesium isn't routinely checked, and sodium restriction isn't specific.
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A nurse is caring for a client who has end-stage kidney disease. The client has decided to stop dialysis treatment. Which of the following actions should the nurse take?
- A. Tell the client she should discuss this decision with her family.
- B. Support the client's decision to stop the treatment.
- C. Discuss alternative treatment methods with the client.
- D. Ask the facility chaplain to visit the client.
Correct Answer: B
Rationale: Supporting the client's decision respects autonomy, a core ethical principle. Discussing with family, alternatives, or involving a chaplain are secondary to honoring the client's choice.
A nurse is caring for a client who has a new diagnosis of diabetes mellitus and is refusing to learn how to self-administer Insulin. Which of the following responses should the nurse make?
- A. Why don't you want to learn how to give yourself your medication?
- B. I'd like to hear your thoughts about giving yourself this medication.
- C. Have you considered how your decision to refuse medication will affect your family?
- D. You will suffer serious health issues if you don't take your medication.
Correct Answer: B
Rationale: Inviting the client to share thoughts encourages open communication and respects their perspective, facilitating understanding of barriers to learning.
A nurse is verifying informed consent for a client who is preoperative for a vaginal hysterectomy. Which of the following statements should the nurse identify as an indication that the client has given informed consent?
- A. I should expect my periods to resume in 1 month.
- B. I will no longer need a regular gynecological examination.
- C. I am thankful I am done having children.
- D. I will have a large scar on my stomach after this procedure.
Correct Answer: C
Rationale: The statement about being done having children shows the client understands the procedure's impact on fertility, a key component of informed consent. The other statements reflect misunderstandings about the procedure's outcomes.
A nurse is reinforcing teaching with a client who has a new prescription for amoxicillin. Which of the following instructions should the nurse include?
- A. Take this medication with an antacid to prevent stomach upset.
- B. You might experience diarrhea while taking this medication.
- C. You need to refrigerate this medication.
- D. You should stop taking this medication if you feel better.
Correct Answer: B
Rationale: Amoxicillin can cause diarrhea, a common side effect. Antacids aren't needed, refrigeration depends on form, and stopping early risks resistance.
A nurse is reinforcing teaching with a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching?
- A. I can take aspirin for a headache.
- B. I might need to have my blood tested regularly.
- C. I should increase my intake of green leafy vegetables.
- D. I can stop taking this medication once my clot dissolves.
Correct Answer: B
Rationale: Warfarin requires regular INR monitoring to ensure therapeutic levels. Aspirin increases bleeding risk, leafy greens affect efficacy, and stopping risks recurrence.