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A nurse is preparing to turn a client who is obese following a spinal fusion. The nurse should plan to use which of the following techniques to turn this client?
- A. Draw sheet
- B. Log roll
- C. Sliding board
- D. Hoyer lift
Correct Answer: B
Rationale: The correct answer is B: Log roll. When turning an obese client following spinal fusion, using a log roll technique is most appropriate. This technique involves turning the client as a single unit to prevent twisting or bending of the spine, reducing the risk of injury. The nurse should assist the client by coordinating the movement with other staff members to ensure a smooth and safe transition. The other choices are not suitable for this scenario: A) Draw sheet is typically used for moving a client up in bed, not for turning an obese client after spinal fusion. C) Sliding board is used for transferring clients from one surface to another, not for turning in bed. D) Hoyer lift is used for lifting and transferring clients who are unable to bear weight, not for turning a client in bed.
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A client is to receive enoxaparin 30 mg subcutaneously. Available is enoxaparin 40 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 0.8
Rationale: To calculate the mL of enoxaparin needed, divide the desired dose (30 mg) by the concentration (40 mg/mL): 30 mg / 40 mg/mL = 0.75 mL. Since the answer should be rounded to the nearest tenth, 0.75 rounds up to 0.8 mL. Therefore, the correct answer is 0.8 mL.
Choice A (0.5 mL) is incorrect as it is not the result of the calculation. Choices B, C, D, E, F, and G are also incorrect as they do not match the correct answer derived from the calculation.
A nurse is caring for a client who is participating in a research study for an experimental chemotherapy medication. After three treatments, the experimental medication is discontinued due to evidence of rapidly advancing kidney failure. The nurse should understand discontinuing this medication demonstrates which of the following ethical principles?
- A. Veracity
- B. Fidelity
- C. Nonmaleficence
- D. Autonomy
Correct Answer: C
Rationale: The correct answer is C: Nonmaleficence. This principle of ethics requires healthcare providers to do no harm to their patients. In this scenario, discontinuing the experimental chemotherapy medication after evidence of rapidly advancing kidney failure demonstrates the nurse's commitment to preventing further harm to the client. By stopping the medication that is causing harm, the nurse is upholding the principle of nonmaleficence.
Other choices are incorrect:
A: Veracity - Veracity pertains to truthfulness and honesty in communication with patients. Discontinuing the medication is not related to truthfulness.
B: Fidelity - Fidelity refers to the obligation to fulfill commitments and promises made to patients. Discontinuing the medication is not about fulfilling commitments.
D: Autonomy - Autonomy is the right of patients to make their own decisions about their healthcare. Discontinuing the medication is not about respecting the patient's autonomy in this context.
A nurse is preparing to administer ciprofloxacin to a client. The nurse should identify that the medication is treatment for exposure to which of the following agents?
- A. Smallpox
- B. Anthrax
- C. Ebola virus
- D. Sarin gas
Correct Answer: B
Rationale: The correct answer is B: Anthrax. Ciprofloxacin is an antibiotic commonly used to treat anthrax, which is a bacterial infection caused by Bacillus anthracis. The rationale behind this choice is that ciprofloxacin is effective in treating anthrax infections by inhibiting the growth of the bacteria. Smallpox (A), Ebola virus (C), and Sarin gas (D) are not treated with ciprofloxacin as they are caused by a virus, a different virus, and a nerve gas, respectively.
A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?
- A. Akathisia
- B. Tardive dyskinesia
- C. Dystonia
Correct Answer: B
Rationale: The correct answer is B: Tardive dyskinesia. Tardive dyskinesia is a common adverse effect of long-term antipsychotic medication use, such as chlorpromazine. It is characterized by involuntary movements of the tongue and face. This condition is often irreversible and can be distressing for the client. Akathisia (choice A) is a different extrapyramidal side effect characterized by restlessness and the urge to move constantly. Dystonia (choice C) is another extrapyramidal side effect that presents as sustained muscle contractions causing abnormal postures. In this case, the symptoms described in the question are more indicative of tardive dyskinesia due to the specific type of involuntary movements observed in the client.
A nurse is assessing a client who is receiving metoprolol. Which of the following indicates a therapeutic effect?
- A. Decreased blood pressure.
- B. Decreased dysrhythmias.
- C. Increased urine output.
- D. Decreased pulse.
Correct Answer: A
Rationale: The correct answer is A: Decreased blood pressure. Metoprolol is a beta-blocker that works by reducing heart rate and decreasing the workload on the heart, leading to a decrease in blood pressure. This is a therapeutic effect as it helps manage conditions like hypertension and angina.
Incorrect choices:
B: Decreased dysrhythmias - While metoprolol can help reduce dysrhythmias, the primary therapeutic effect is on blood pressure.
C: Increased urine output - Metoprolol does not directly affect urine output.
D: Decreased pulse - Decreasing pulse is a common side effect of metoprolol, but the therapeutic effect is primarily on blood pressure.