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A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take?
- A. Check the client's blood glucose levels regularly.
- B. Administer TPN through a peripheral IV line.
- C. Change the TPN bag every 48 hr.
- D. Monitor the client's blood pressure every 4 hr.
Correct Answer: A
Rationale: TPN's high glucose content requires regular blood glucose monitoring to prevent hyperglycemia. It's given centrally, bags change every 24 hours, and blood pressure isn't specific.
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A nurse is reinforcing teaching with a client who is scheduled for a colonoscopy. Which of the following statements should the nurse include?
- A. You will be given a sedative during the procedure.
- B. You can eat a light breakfast the morning of the procedure.
- C. You will need to maintain a clear liquid diet for 3 days prior to the procedure.
- D. You will need to take an antibiotic before the procedure.
Correct Answer: A
Rationale: A sedative is used to ensure comfort during a colonoscopy. Clear liquids are required only 1-2 days prior, no food is allowed the morning of, and antibiotics aren't standard.
A nurse is reinforcing teaching with a client who has a new prescription for valsartan. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should take this medication with a high-potassium meal.
- B. I might need to check my blood pressure regularly.
- C. I need to avoid exercise.
- D. I can stop taking this medication if I feel better.
Correct Answer: B
Rationale: Valsartan requires blood pressure monitoring, showing understanding. Potassium meals, exercise avoidance, and stopping abruptly aren't appropriate.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse report to the provider?
- A. The client's blood glucose is 120 mg/dL.
- B. The client's temperature is 38.3°C (100.9°F).
- C. The client's weight increased by 0.5 kg overnight.
- D. The client reports mild discomfort at the IV site.
Correct Answer: B
Rationale: A temperature of 38.3°C suggests infection, possibly catheter-related, requiring reporting. Normal glucose, slight weight gain, and mild discomfort are less urgent.
A nurse is caring for a client who is receiving a blood transfusion. Which of the following actions should the nurse take if a transfusion reaction is suspected?
- A. Increase the infusion rate.
- B. Administer diphenhydramine.
- C. Stop the transfusion.
- D. Elevate the client's legs.
Correct Answer: C
Rationale: Stopping the transfusion prevents further reaction. Increasing the rate worsens it, diphenhydramine is secondary, and leg elevation is unrelated.
A nurse is reinforcing teaching with a client who has a new prescription for esomeprazole. Which of the following statements should the nurse include?
- A. You should take this medication at bedtime.
- B. You might experience headache while taking this medication.
- C. You need to avoid dairy products while taking this medication.
- D. You can take this medication with an antacid for best results.
Correct Answer: B
Rationale: Esomeprazole can cause headaches, a side effect to monitor. It's taken before meals, dairy isn't restricted, and antacids don't enhance efficacy.