A nurse is reviewing the laboratory results of a client who has hypocalcemia. Which of the following findings should the nurse expect?
- A. Positive Trousseau's sign
- B. Increased deep tendon reflexes
- C. Hyperactive bowel sounds
- D. Weak, thready pulse
Correct Answer: A
Rationale: A positive Trousseau's sign is a key finding in clients with hypocalcemia, indicating neuromuscular irritability. The other choices are not typically associated with hypocalcemia. Increased deep tendon reflexes are more indicative of hypercalcemia. Hyperactive bowel sounds can be seen in hyperactive bowel conditions or diarrhea, not specifically related to hypocalcemia. A weak, thready pulse may indicate cardiovascular issues, such as dehydration, but it is not a typical finding in hypocalcemia.
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A nurse is teaching a client who has a new prescription for fluoxetine. Which of the following statements should the nurse include?
- A. "You should expect to feel an improvement in your symptoms within 1 week."
- B. "You may experience weight gain while taking this medication."
- C. "You should take this medication in the morning to prevent insomnia."
- D. "You should stop taking this medication if you experience dry mouth."
Correct Answer: B
Rationale: The correct statement the nurse should include is that the client may experience weight gain while taking fluoxetine. Weight gain is a common side effect of fluoxetine, and patients should be informed about this potential issue. Stating that the client should expect improvement in symptoms within 1 week (Choice A) is incorrect as fluoxetine may take a few weeks to have a noticeable effect. Taking the medication in the morning to prevent insomnia (Choice C) is not necessary since fluoxetine can be taken at any time of the day. Instructing the client to stop taking the medication if experiencing dry mouth (Choice D) is misleading, as dry mouth is a common but usually not serious side effect of fluoxetine.
A nurse is assessing a client who is 1 day postoperative following hip replacement surgery. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 88/min
- B. Serosanguineous drainage on the surgical dressing
- C. Blood pressure of 118/76 mm Hg
- D. Urine output of 40 mL/hr
Correct Answer: D
Rationale: The correct answer is D: Urine output of 40 mL/hr. A low urine output may indicate kidney complications, such as acute kidney injury, which is a critical finding postoperatively. The nurse should report this immediately to the provider for further evaluation and management. Choices A, B, and C are within normal limits for a client who is 1 day postoperative following hip replacement surgery and do not indicate immediate concerns that require reporting to the provider.
A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?
- A. Take this medication with meals to prevent nausea.
- B. Avoid drinking alcohol while taking this medication.
- C. Avoid eating foods high in potassium.
- D. Monitor for signs of infection.
Correct Answer: D
Rationale: The correct answer is D: 'Monitor for signs of infection.' Clopidogrel affects platelet levels, increasing the risk of bleeding. Therefore, it is essential for clients taking clopidogrel to monitor for signs of infection, which could indicate a lowered immune response. Choices A, B, and C are incorrect because they do not directly relate to the specific monitoring needs associated with clopidogrel therapy.
A nurse is teaching a prenatal class about infections. Which statement by a participant indicates a need for further teaching?
- A. I can clean the cat's litter box during pregnancy.
- B. I can visit someone with the flu after receiving the vaccine.
- C. I should take antibiotics for viral infections.
- D. I should wash my hands after gardening.
Correct Answer: C
Rationale: The correct answer is C. This statement indicates a need for further teaching because antibiotics are ineffective against viral infections. It is important to educate the participant that antibiotics are only effective against bacterial infections, not viral ones. Choices A, B, and D are correct statements that promote good hygiene practices and infection prevention during pregnancy.
A healthcare provider is teaching a client who has a new diagnosis of hypertension about dietary management. Which of the following foods should the healthcare provider recommend?
- A. Carrots
- B. Whole grains
- C. Lean beef
- D. Bananas
Correct Answer: C
Rationale: The correct answer is 'Lean beef.' Lean beef is a good source of protein, which is essential for a balanced diet. While carrots and bananas are healthy food choices, they are not specifically recommended for clients with hypertension. Whole grains are a better alternative to refined grains for individuals with hypertension, but lean beef is a more suitable recommendation due to its protein content.
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