Nokea
A nurse is reinforcing teaching with a client who has a new prescription for alendronate for the treatment of osteoporosis. The nurse should instruct the client to monitor for which of the following adverse effects?
- A. Anorexia
- B. Jaw pain
- C. Insomnia
- D. Bruising
Correct Answer: B
Rationale: The correct answer is B: Jaw pain. Alendronate, a bisphosphonate medication used to treat osteoporosis, can cause a rare but serious side effect called osteonecrosis of the jaw (ONJ), characterized by jaw pain, swelling, and possible infection. It is essential for the nurse to instruct the client to monitor for any signs of jaw pain to promptly report to their healthcare provider. Anorexia (A), insomnia (C), and bruising (D) are not typically associated with alendronate use for osteoporosis and would not be common adverse effects that the client needs to monitor for.
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A nurse is collecting data from a client who is taking prednisone and self-administers insulin daily. The nurse should identify that which of the following findings indicates a medication interaction?
- A. Orthostatic hypotension
- B. Hyperglycemia
- C. Paresthesia
- D. Jaundice
Correct Answer: B
Rationale: The correct answer is B: Hyperglycemia. Prednisone can increase blood sugar levels, and insulin is used to lower blood sugar levels. If the client is experiencing hyperglycemia while taking both medications, it indicates a possible medication interaction. Orthostatic hypotension (A) is not typically associated with this medication combination. Paresthesia (C) and jaundice (D) are not commonly related to prednisone and insulin interactions.
A nurse is collecting data from a client who reports nausea and has vomited clear emesis. Which of the following medications should the nurse administer?
- A. Meperidine
- B. Diazepam
- C. Naloxone
- D. Promethazine
Correct Answer: D
Rationale: The correct answer is D: Promethazine. Promethazine is an antiemetic medication commonly used to treat nausea and vomiting. It works by blocking dopamine receptors in the brain, reducing the feeling of nausea. Meperidine (A) is a pain medication and not indicated for nausea. Diazepam (B) is a benzodiazepine used for anxiety and seizures, not for nausea. Naloxone (C) is an opioid antagonist used for opioid overdose, not for nausea.
A nurse is reinforcing teaching with a newly licensed nurse about monitoring morphine patient-controlled analgesia (PCA). Which of the following information should the nurse include?
- A. Instruct the client's visitors not to operate the PCA pump.'
- B. Check the client's pain level every 8 hours.'
- C. Diarrhea is an adverse effect of morphine PCA.'
- D. Using morphine PCA increases the client's risk of toxicity.'
Correct Answer: A
Rationale: The correct answer is A, instruct the client's visitors not to operate the PCA pump. This is important to prevent unauthorized administration of medication by individuals who are not trained to use the PCA pump, ensuring patient safety. Checking the client's pain level every 8 hours (B) is important but not the priority in monitoring PCA. Diarrhea is not a common adverse effect of morphine PCA (C), and using morphine PCA does not inherently increase the client's risk of toxicity (D) if used appropriately.
A nurse is caring for a client who is receiving heparin therapy. If the client requires a reversal of the effects of heparin, which of the following medications should the nurse expect the provider to prescribe?
- A. Atropine
- B. Vitamin K
- C. Vitamin B12
- D. Protamine
Correct Answer: D
Rationale: The correct answer is D: Protamine. Protamine is the antidote for heparin as it works by forming a complex with heparin, neutralizing its anticoagulant effects. Atropine (A) is used for bradycardia, not for heparin reversal. Vitamin K (B) is used to reverse the effects of warfarin, a different anticoagulant. Vitamin B12 (C) is not used for heparin reversal. Therefore, the correct choice is Protamine (D) for reversing heparin's effects.
Vital Signs
Nurses Notes
History and Physical
Initial visit:
Temperature 36.5° C (97.7° F)
Heart rate 68/min
Blood pressure 116/70 mm Hg
Respiratory rate 16/min
SpO2 98% on room air
Follow-up visit 2 weeks later:
Temperature 36.7° C (98.1°F)
Heart rate 86/min
Blood pressure 130/80 mm Hg
Respiratory rate 18/min
SpO2 99% on room air
Select the 6 statements the nurse should include when reinforcing teaching to the client about the newly prescribed medication (sumatriptan).
- A. Do not take more than 200 milligrams of this medication within 24 hours.'
- B. You can take a second dose of this medication at least 2 hours after the initial dose if the headache persists.'
- C. You should discontinue this medication if pregnancy is planned or suspected.'
- D. You might experience a rash on your skin while taking this medication.'
- E. You might experience a feeling of pressure in your chest after taking this medication.'
- F. This medication can cause you to feel tired.'
- G. This medication should start to alleviate the headache within 1 hour.'
Correct Answer: A,B,C,E,F,G
Rationale: The correct statements are A, B, C, E, F, and G. A: Correct dose limit to prevent overdose. B: Advises on timing for second dose if needed. C: Important to stop if pregnancy is planned. E: Chest pressure is a potential side effect. F: Fatigue is a possible side effect. G: Expected time frame for headache relief. These statements cover dosage, timing, potential side effects, pregnancy precautions, and expected outcomes. Other options lack crucial information or provide incorrect guidance, such as D, which mentions a rash that is not a common side effect of sumatriptan.