Nokea
A nurse is reinforcing dietary teaching with a client whose pre-pregnancy BMI was 30.5. The nurse should include which of the following is an acceptable weight gain for this client?
- A. 16 lb
- B. 32 lb
- C. 24 lb
- D. 8 lb
Correct Answer: A
Rationale: For a BMI of 30.5 (obese), a weight gain of 11-20 pounds is recommended. 16 pounds falls within this range, supporting healthy pregnancy outcomes without excess gain.
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A nurse is caring for a client who is receiving IV vancomycin. Which of the following actions should the nurse take?
- A. Infuse the medication over 30 min.
- B. Monitor the client for tinnitus.
- C. Administer the medication with an antihistamine.
- D. Check the client's blood pressure every 4 hr.
Correct Answer: B
Rationale: Vancomycin can cause ototoxicity, so monitoring for tinnitus is essential. It's infused over 60-90 minutes, antihistamines aren't needed, and blood pressure checks aren't specific to vancomycin.
A nurse is reinforcing teaching with a client who has a new prescription for insulin glargine. Which of the following instructions should the nurse include?
- A. Take this insulin with meals.
- B. You might gain weight while taking this insulin.
- C. Shake the vial before drawing up the insulin.
- D. Use this insulin only when your blood sugar is high.
Correct Answer: B
Rationale: Insulin glargine can cause weight gain, a side effect to monitor. It's taken daily, not with meals, shaking is avoided, and it's not for acute highs.
A nurse is reinforcing teaching with a client who has a new prescription for venlafaxine. Which of the following statements should the nurse include?
- A. You should take this medication with food.
- B. You might experience headaches while taking this medication.
- C. You need to avoid caffeine while taking this medication.
- D. You can expect symptom relief within 24 hours.
Correct Answer: B
Rationale: Venlafaxine can cause headaches, a common side effect. Food enhances absorption, caffeine isn't restricted, and relief takes weeks.
A nurse is reinforcing teaching with a client who has a new prescription for montelukast. Which of the following statements should the nurse include?
- A. You should take this medication in the evening.
- B. You might experience weight gain while taking this medication.
- C. You need to limit your fluid intake while taking this medication.
- D. You can take this medication with an antacid.
Correct Answer: A
Rationale: Montelukast is taken in the evening for asthma control. Weight gain, fluid limits, or antacids aren't significant concerns.
A nurse is caring for a client who has a new diagnosis of diabetes mellitus and is refusing to learn how to self-administer Insulin. Which of the following responses should the nurse make?
- A. Why don't you want to learn how to give yourself your medication?
- B. I'd like to hear your thoughts about giving yourself this medication.
- C. Have you considered how your decision to refuse medication will affect your family?
- D. You will suffer serious health issues if you don't take your medication.
Correct Answer: B
Rationale: Inviting the client to share thoughts encourages open communication and respects their perspective, facilitating understanding of barriers to learning.