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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.
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A nurse is caring for a client who is postoperative following a prostatectomy. Which of the following actions should the nurse take?
- A. Monitor the client's urine output every 2 hr.
- B. Instruct the client to resume a high-fiber diet immediately.
- C. Apply a cold pack to the perineal area.
- D. Encourage the client to sit for prolonged periods.
Correct Answer: A
Rationale: Monitoring urine output detects complications like obstruction. High-fiber diets resume gradually, cold packs aren't standard, and prolonged sitting risks discomfort.
A nurse in an acute care setting is assisting in collecting client information to include in a referral for a physical therapist. Which of the following information should the nurse plan to include?
- A. Family medical history
- B. Medical health insurance claims
- C. Physical assessment findings
- D. Medications taken prior to admission
Correct Answer: C
Rationale: Physical assessment findings like mobility or pain are critical for a physical therapist to develop a tailored plan. Family history, insurance, or past medications are less relevant.
A nurse is caring for a client who is receiving IV chemotherapy. Which of the following findings should the nurse report to the provider?
- A. The client reports mild fatigue.
- B. The client's IV site is cool and swollen.
- C. The client's urine output is 200 mL over 4 hr.
- D. The client's temperature is 37.2°C (99°F).
Correct Answer: B
Rationale: A cool, swollen IV site suggests extravasation, a chemotherapy emergency requiring reporting. Fatigue, normal urine output, and mild fever are less urgent.
A nurse is reinforcing teaching with a client who has a new prescription for doxycycline. Which of the following instructions should the nurse include?
- A. Take this medication with an antacid.
- B. You might need to wear sunscreen while taking this medication.
- C. You need to refrigerate this medication.
- D. You should stop taking this medication if you feel better.
Correct Answer: B
Rationale: Doxycycline increases photosensitivity, requiring sunscreen. Antacids reduce absorption, refrigeration isn't needed, and stopping early risks resistance.
A nurse is caring for a client who is receiving IV gentamicin. Which of the following actions should the nurse take?
- A. Monitor the client's hearing.
- B. Administer the medication over 15 min.
- C. Check the client's blood glucose levels.
- D. Instruct the client to increase fluid intake.
Correct Answer: A
Rationale: Gentamicin risks ototoxicity, so hearing monitoring is critical. It's infused slowly, glucose isn't affected, and fluid intake depends on condition.