Nokea
A nurse is reinforcing teaching with a client who has motion sickness and a new prescription for a transdermal patch of scopolamine. The nurse should instruct the client to monitor for which of the following adverse effects?
- A. Diarrhea
- B. Bruising
- C. Jaundice
- D. Drowsiness
Correct Answer: D
Rationale: The correct answer is D: Drowsiness. Scopolamine is an anticholinergic medication commonly used to treat motion sickness. One of the common side effects of anticholinergics is drowsiness. This occurs due to the central nervous system depressant effects of the medication. Monitoring for drowsiness is important as it can impact the client's ability to drive or operate machinery safely.
A: Diarrhea is not a common side effect of scopolamine.
B: Bruising is not a common side effect of scopolamine.
C: Jaundice is not a common side effect of scopolamine.
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A nurse is caring for a client who had abdominal surgery. The client is grimacing and has a respiratory rate of 24/min. Which of the following actions should the nurse take first?
- A. Check the client's current level of pain.
- B. Play music in the client's room as a distraction.
- C. Assist the client to reposition in bed.
- D. Offer the client a cold compress.
Correct Answer: A
Rationale: The correct answer is A, checking the client's current level of pain. This is the priority because the client is grimacing, indicating discomfort. Assessing the pain level is crucial in determining the appropriate intervention. It helps in providing timely pain relief and ensuring the client's well-being. Choices B, C, and D are incorrect because they do not address the immediate need of assessing and managing the client's pain. Playing music, repositioning the client, or offering a cold compress may be helpful interventions, but they should come after evaluating the client's pain level.
A nurse is preparing to administer gentamicin to a child who weighs 44 lb. The provider prescribes 6 mg/kg/day IV to be administered in three equal doses. Available is gentamicin 40 mg/mL. How many mL should the nurse administer with each dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 1 mL
Rationale: The correct answer is 1 mL. To calculate the dose for each administration, first convert the child's weight from pounds to kilograms (44 lb = 20 kg). The total daily dose is 6 mg/kg/day, so for a 20 kg child, the total daily dose is 120 mg (6 mg/kg/day x 20 kg). Since it is to be given in three equal doses, each dose would be 40 mg (120 mg total dose ÷ 3 doses). Since the available concentration is 40 mg/mL, the nurse would administer 1 mL for each dose (40 mg ÷ 40 mg/mL = 1 mL). Therefore, the correct answer is 1 mL.
Incorrect answers:
- Choice B: This is incorrect as it does not follow the correct calculation method.
- Choice C: This is incorrect as it does not consider the weight of the child and the total daily dose required.
- Choice D: This is incorrect as it does not
A nurse is caring for a client who has been taking epoetin alfa for 3 months. Which of the following laboratory tests should the nurse monitor to determine the effectiveness of the medication?
- A. Hgb
- B. Troponin
- C. Thyroxine (T4)
- D. Aspartate aminotransferase (AST)
Correct Answer: A
Rationale: The correct answer is A: Hgb. Epoetin alfa is a medication used to treat anemia by stimulating red blood cell production. Monitoring the client's hemoglobin (Hgb) levels is crucial to assess the effectiveness of the medication in increasing red blood cell count. Hemoglobin reflects the oxygen-carrying capacity of the blood and directly correlates with red blood cell levels. Troponin (B), Thyroxine (T4) (C), and Aspartate aminotransferase (AST) (D) are not relevant in monitoring the effectiveness of epoetin alfa therapy as they are related to cardiac function, thyroid function, and liver function, respectively.
A nurse in a provider's office is collecting data from a client who continues to have a migraine headache after taking sumatriptan orally 2 hr ago. Which of the following findings is the priority for the nurse to report?
- A. Tingling sensation
- B. Hypertension
- C. Flushing
- D. Dizziness
Correct Answer: B
Rationale: The correct answer is B: Hypertension. The priority for the nurse to report is hypertension because sumatriptan can potentially cause an increase in blood pressure as a side effect. Hypertension is a serious condition that can lead to complications if not managed promptly.
A: Tingling sensation is a common side effect of sumatriptan and may not be immediately concerning.
C: Flushing is also a common side effect of sumatriptan and is usually not a priority.
D: Dizziness is a less severe side effect compared to hypertension and can often be managed with rest.
A nurse is reinforcing teaching about the pledge program with a female client who has a new prescription for…. The nurse should tell the client that which of the following is a requirement of the program?
- A. Clients must have a Papanicolaou test every 6 months during treatment.
- B. Clients must begin a daily supplement of vitamin A for 1 month prior to initiating therapy.
- C. Sexually active female clients must use two forms of birth control during treatment.
- D. Female clients must have a negative mammogram prior to beginning therapy.
Correct Answer: C
Rationale: The correct answer is C: Sexually active female clients must use two forms of birth control during treatment. This requirement is crucial to prevent pregnancy due to the potential teratogenic effects of the medication on the fetus. Using two forms of birth control provides an extra layer of protection.
Other choices are incorrect:
A: Having a Papanicolaou test every 6 months is not a specific requirement of the program.
B: Starting a daily supplement of vitamin A is not a requirement for the pledge program.
D: Having a negative mammogram is not directly related to the pledge program's requirements.