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A nurse is conducting discharge teaching for a patient who has seizures and a new prescription for phenytoin. Which statements by the patient indicate a need for further teaching? Which statement indicates a need for phenytoin teaching?
- A. I know that I cannot switch brands of this medication.
- B. I have made an appointment to see my dentist next week.
- C. I will notify my doctor before taking any other medications.
- D. I'll be glad when I can stop taking this medicine.
Correct Answer: D
Rationale: The correct answer is D: "I'll be glad when I can stop taking this medicine." This statement indicates a need for further teaching because phenytoin is typically a lifelong medication for managing seizures. Stopping it abruptly can lead to serious consequences such as increased risk of seizures. Therefore, the patient should be educated on the importance of adhering to the prescribed regimen.
Choice A is correct because it emphasizes the importance of not switching brands of phenytoin, as different formulations may have varying levels of the active ingredient. Choice B is important for overall health but not directly related to phenytoin teaching. Choice C is also crucial as phenytoin can interact with other medications, so notifying the doctor is necessary.
In summary, choice D is incorrect because discontinuing phenytoin without medical supervision can be harmful. Choices A, B, and C are correct as they address important aspects of managing phenytoin therapy.
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A nurse is obtaining a preoperative medical and surgical history from a patient scheduled for a cataract extraction procedure. Which of the following patient statements require further investigation by the nurse? Which statement requires further investigation pre-cataract surgery?
- A. I stopped taking aspirin last week.
- B. I took my blood pressure meds with a sip of water.
- C. I did not put my contact lenses in this morning.
- D. I had a cough and runny nose a couple days ago.
Correct Answer: D
Rationale: The correct answer is D because having a cough and runny nose a couple of days ago could indicate a potential respiratory infection, which may increase the risk of complications during surgery. The nurse should further investigate the severity and duration of the symptoms, as well as any current treatment or resolution.
A: Stopping aspirin last week is appropriate to reduce bleeding risk during surgery.
B: Taking blood pressure meds with water is standard practice and not concerning.
C: Not wearing contact lenses is normal before eye surgery to prevent complications.
In summary, choice D requires further investigation due to the possible impact on the patient's respiratory health, while the other choices are not directly related to the surgery or pose significant risks.
A nurse is caring for a patient receiving epidural analgesia for pain during labor. Which of the following observations should be the nurse's priority? Which observation is the priority for epidural analgesia?
- A. The patient's blood pressure is 80/56 mm Hg.
- B. The patient reports lower extremity weakness.
- C. The patient's temperature is 38.2°C (100.8 F).
- D. The patient reports severe itching.
Correct Answer: A
Rationale: The correct answer is A: The patient's blood pressure is 80/56 mm Hg. This is the priority observation because hypotension is a common side effect of epidural analgesia, which can lead to decreased perfusion and compromise fetal well-being. Lower extremity weakness (B) is expected due to the effect of the epidural. Temperature elevation (C) can be due to various factors unrelated to the epidural. Severe itching (D) can be a side effect but is not life-threatening like hypotension.
A nurse is conducting a class on medication reconciliation. What information should the nurse include in the teaching?,What information should be included in medication reconciliation teaching?
- A. Provide a list of the client's current medications during the change of shift report.
- B. Do not include over-the-counter medications in the medication reconciliation report.
- C. Do not perform reconciliation for a client at discharge from a health care facility.
- D. Provide a list of the client's current medications during admission to a health care facility.
Correct Answer: D
Rationale: The correct answer is D: Provide a list of the client's current medications during admission to a health care facility. This is essential in medication reconciliation to ensure that the healthcare team has accurate information about the client's current medications to prevent medication errors. During admission, it is crucial to compare the client's current medication list with the medications prescribed by the healthcare facility to identify any discrepancies. This information is vital for safe and effective care delivery.
Incorrect choices:
A: Providing a list of the client's current medications during the change of shift report is important but not specific to medication reconciliation during admission.
B: Over-the-counter medications should be included in the medication reconciliation report as they can interact with prescription medications.
C: Medication reconciliation should be performed at discharge to ensure a smooth transition of care and prevent medication discrepancies at home.
A nurse is assisting a healthcare provider with a sterile procedure and is preparing to pour solution onto a sterile piece of gauze. In what sequence should the nurse perform the following steps when pouring the sterile solution? In what sequence should the nurse pour sterile solution?
- A. Pick up the bottle with the label facing the palm.
- B. Pour the solution onto the gauze.
- C. Pour 1 to 2 mL into a receptacle.
- D. Perform hand hygiene.
- E. Place the bottle cap face-up on a clean surface.
- F. Remove the bottle cap.
Correct Answer: D,A,F,C,E,B
Rationale: The correct sequence is D, A, F, C, E, B.
1. Perform hand hygiene to ensure cleanliness.
2. Pick up the bottle with the label facing the palm to maintain sterility.
3. Remove the bottle cap to prepare for pouring.
4. Pour 1 to 2 mL into a receptacle to ensure proper amount.
5. Place the bottle cap face-up on a clean surface to prevent contamination.
6. Pour the solution onto the gauze for the sterile procedure to be completed.
Incorrect choices:
- G: It is not a step in the process of pouring sterile solution.
- The correct order ensures sterility, proper amount, and prevention of contamination.
A nurse is educating a patient with diabetes who has been prescribed insulin glargine. What information should the nurse provide about this type of insulin?,What information should be provided about insulin glargine?
- A. Insulin glargine lasts for 3 to 6 hours.
- B. Insulin glargine lasts for 18 to 24 hours.
- C. Insulin glargine lasts for 16 to 24 hours.
- D. Insulin glargine lasts for 6 to 10 hours.
Correct Answer: B,C
Rationale: The correct answer is B and C. Insulin glargine is a long-acting insulin that provides a basal level of insulin over an extended period. Option B states that it lasts for 18 to 24 hours, which is accurate as it mimics the body's natural basal insulin secretion. Option C also mentions 16 to 24 hours, which is within the range of the duration of action for insulin glargine. Option A stating 3 to 6 hours is incorrect as it does not reflect the long-acting nature of insulin glargine. Option D stating 6 to 10 hours is also incorrect as it underestimates the duration. It is important for the nurse to emphasize the prolonged action of insulin glargine to ensure proper understanding and management by the patient.