Nokea
A nurse is preparing to administer potassium chloride IV to a client. Which of the following actions should the nurse take to prevent complications?
- A. Administer the medication by IV bolus over 2 minutes
- B. Infuse the medication slowly using an IV pump
- C. Add the medication to an IV solution of D5W
- D. Dilute the medication in 5 mL of sterile water
Correct Answer: B
Rationale: The correct action to prevent complications when administering potassium chloride IV is to infuse the medication slowly using an IV pump. Rapid administration of potassium chloride can lead to complications such as hyperkalemia and cardiac arrest. Options A, C, and D are incorrect as they do not promote the safe administration of potassium chloride. Administering the medication by IV bolus over 2 minutes is too rapid and can cause adverse effects. Adding the medication to an IV solution of D5W or diluting it in sterile water may not control the rate of administration, increasing the risk of complications.
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A nurse is caring for a client taking ciprofloxacin for an infection. Which of the following adverse effects should the nurse include in the client education?
- A. Constipation
- B. Tendon rupture
- C. Dry mouth
- D. Nasal congestion
Correct Answer: B
Rationale: The correct answer is B: Tendon rupture. Ciprofloxacin belongs to the fluoroquinolone class of antibiotics, which is associated with the adverse effect of tendon rupture. Tendon rupture is a severe but rare side effect that can occur with the use of ciprofloxacin. Educating the client about this potential adverse effect is crucial to promote awareness and early recognition of symptoms, such as tendon pain, swelling, or inflammation. Choices A, C, and D are not typically associated with ciprofloxacin use and are less relevant for client education in this scenario.
A healthcare provider is preparing to administer heparin sodium to a client with deep vein thrombosis (DVT). Which of the following laboratory values should the provider monitor during therapy?
- A. INR
- B. Serum creatinine
- C. aPTT
- D. Bilirubin
Correct Answer: C
Rationale: The correct answer is C: aPTT. The healthcare provider should monitor the activated partial thromboplastin time (aPTT) value during heparin therapy to assess the client's coagulation status. Heparin affects the intrinsic pathway of the coagulation cascade, and monitoring aPTT helps ensure that the client is within the therapeutic range to prevent bleeding or clotting issues. INR (Choice A) is used to monitor warfarin therapy, not heparin. Serum creatinine (Choice B) is not directly related to monitoring heparin therapy. Bilirubin (Choice D) is related to liver function, not heparin therapy.
A nurse is reviewing a client's medication regimen. Which of the following medications places the client at increased risk for digoxin toxicity?
- A. Calcium channel blockers
- B. Potassium-sparing diuretics
- C. Beta blockers
- D. Loop diuretics
Correct Answer: D
Rationale: The correct answer is D, Loop diuretics. Loop diuretics can lead to hypokalemia, which increases the risk for digoxin toxicity. Loop diuretics cause potassium loss, and hypokalemia can potentiate the toxic effects of digoxin. Choices A, B, and C are incorrect because calcium channel blockers, potassium-sparing diuretics, and beta blockers do not directly increase the risk of digoxin toxicity.
Before administering blood products, which action should be taken?
- A. Assess the client's temperature
- B. Document client response
- C. Prime IV tubing with 0.45% sodium chloride
- D. Administer epinephrine
Correct Answer: A
Rationale: Correct answer: Before administering blood products, the client's temperature must be assessed to establish a baseline and monitor for transfusion reactions. Choice B is incorrect because documenting client response should occur after administering the blood products. Choice C is incorrect as priming IV tubing with 0.45% sodium chloride is not directly related to assessing the client before administering blood products. Choice D is incorrect because administering epinephrine is not a routine action before administering blood products.
A healthcare provider is preparing to administer bisacodyl suppository to a client. Which of the following actions should the healthcare provider take?
- A. Don sterile gloves
- B. Lubricate index finger
- C. Use a rectal applicator for insertion
- D. Position client supine with knees bent
Correct Answer: B
Rationale: The correct action when administering a bisacodyl suppository is to lubricate the index finger for easier insertion. Using a rectal applicator for insertion is not recommended for bisacodyl suppositories. Positioning the client supine with knees bent is not necessary for the administration of a bisacodyl suppository. While wearing gloves is important for infection control, sterile gloves are not required for this procedure.