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The client has pyelonephritis and is receiving gentamicin via IV infusion.
A nurse is collecting data from a client who has pyelonephritis and is receiving gentamicin via IV infusion. Which of the following manifestations should the nurse identify as an adverse effect of the treatment?
- A. New onset of hearing loss
- B. Slurred speech
- C. Constipation
- D. Hypotension
Correct Answer: A
Rationale: Gentamicin can cause ototoxicity, leading to hearing loss.
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The client is in renal failure.
A nurse is collecting data from a client who is in renal failure. Which of the following findings should the nurse identify as a manifestation of hyperkalemia?
- A. Dry mucous membranes
- B. Hyperactive reflexes
- C. Trousseau's sign
- D. Irregular heart rate
Correct Answer: D
Rationale: Irregular heart rate is a hallmark of hyperkalemia due to its effect on cardiac conduction.
The client tells the nurse they do not want to be resuscitated in the event of a cardiac arrest.
A nurse is caring for a client who has lung cancer. The client tells the nurse they do not want to be resuscitated in the event of a cardiac arrest. Which of the following statements should the nurse make?
- A. Let me explain the pros and cons of your decision.
- B. I will support your decision and help you explain it to others.
- C. I will send the social worker in to discuss this decision with you.
- D. I suggest you discuss this decision with your family first.
Correct Answer: B
Rationale: Supporting the client's decision respects autonomy and facilitates communication, aligning with ethical care.
The client has heart failure and is taking furosemide.
A nurse is collecting data from a client who has heart failure and is taking furosemide. Which of the following findings should indicate to the nurse that the medication is effective?
- A. Increased urinary output
- B. Decreased hemoglobin level
- C. Increased weight of 0.91 kg (2 lb)
- D. Decreased BUN level
Correct Answer: A
Rationale: Increased urinary output reflects furosemide's diuretic effect, reducing fluid overload.
The client reports having trouble getting to sleep at night.
A nurse is caring for an adult client who reports having trouble getting to sleep at night. Which of the following recommendations should the nurse make?
- A. Remain in bed until you fall asleep.
- B. Keep the television volume low while you are trying to fall asleep.
- C. Sleep longer hours on the weekend.
- D. Establish a daily exercise routine.
Correct Answer: D
Rationale: A daily exercise routine promotes better sleep patterns.
The client's prescription for erythromycin 500 mg four times per day.
A nurse is transcribing a client's prescription for erythromycin 500 mg four times per day. Which of the following information should the nurse clarify with the provider?
- A. Medication
- B. Dosage
- C. Route
- D. Time
Correct Answer: C
Rationale: The route (e.g., PO, IV) is unspecified and requires clarification.