Nokea
A nurse is caring for a client who is receiving IV vancomycin. Which of the following findings should the nurse report to the provider?
- A. Redness at the IV site
- B. Weight gain
- C. Bradycardia
- D. Hypotension
Correct Answer: A
Rationale: Redness at the IV site may indicate phlebitis or infiltration, requiring immediate reporting to prevent complications.
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A nurse is reinforcing teaching with a client who is scheduled for a lumbar puncture. Which of the following instructions should the nurse include?
- A. Avoid eating after midnight before the procedure.
- B. Lie flat for 4 to 6 hours after the procedure.
- C. Expect general anesthesia during the procedure.
- D. Avoid drinking fluids for 12 hours before the procedure.
Correct Answer: B
Rationale: Lying flat for 4 to 6 hours after a lumbar puncture prevents cerebrospinal fluid leakage and reduces headache risk.
A nurse is caring for a client who has a new prescription for isosorbide mononitrate. Which of the following adverse effects should the nurse monitor for?
- A. Headache
- B. Weight gain
- C. Bradycardia
- D. Hypoglycemia
Correct Answer: A
Rationale: Isosorbide mononitrate, a nitrate, commonly causes headaches due to vasodilation, especially when starting therapy.
A nurse is caring for a client who has a new prescription for duloxetine. Which of the following adverse effects should the nurse monitor for?
- A. Insomnia
- B. Weight loss
- C. Bradycardia
- D. Hypoglycemia
Correct Answer: A
Rationale: Duloxetine, an SNRI, can cause insomnia due to its effect on serotonin and norepinephrine levels.
A nurse is caring for a client who has a new prescription for valsartan. Which of the following adverse effects should the nurse monitor for?
- A. Hyperkalemia
- B. Weight loss
- C. Bradycardia
- D. Hypoglycemia
Correct Answer: A
Rationale: Valsartan, an ARB, can cause hyperkalemia by affecting potassium excretion in the kidneys.
A nurse is reinforcing teaching with a new mother about facility security measures. Which of the following statements by the mother indicates an understanding of the teaching?
- A. I will carry my baby to the nursery.
- B. I will have an identification band that matches the one my baby wears.
- C. I can remove my security band to give to a family member.
- D. I can take my baby to the lobby to visit family.
Correct Answer: B
Rationale: Having an identification band that matches the baby's band is correct. Hospital security protocols require that the mother and baby wear matching identification bands to ensure the right baby is with the right parent and prevent infant abduction or misidentification.