Nokea
A nurse is teaching a client about using a metered-dose rescue inhaler. Which of the following statements should the nurse include in the teaching?
- A. Depress the canister after you inhale.'
- B. Exhale fully before bringing the inhaler to your lips.'
- C. Use peroxide to clean the mouthpiece of your inhaler.'
- D. Do not shake your inhaler before use.'
Correct Answer: B
Rationale: The correct answer is B: "Exhale fully before bringing the inhaler to your lips." This statement is important because exhaling fully before inhaling the medication helps to ensure maximum delivery of the medication into the lungs. By exhaling fully, the client creates more space in the lungs for the medication to reach the lower airways effectively.
Choice A is incorrect because depressing the canister after inhaling would not allow the medication to reach the lungs. Choice C is incorrect as peroxide is not recommended for cleaning inhaler mouthpieces. Choice D is incorrect because shaking the inhaler before use is necessary to ensure proper mixing of the medication for effective delivery.
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A nurse is preparing to obtain a guaiac smear sample from a client for fecal occult blood testing. Which of the following actions should the nurse plan to take?
- A. Take the sample from the outer edge of formed stool.
- B. Wear sterile gloves when collecting the sample.
- C. Collect three samples from a single bowel movement.
- D. Discard samples that contain urine.
Correct Answer: D
Rationale: The correct answer is D: Discard samples that contain urine. This is crucial because urine can interfere with the accuracy of the fecal occult blood test results, leading to false positives. By discarding samples that contain urine, the nurse ensures the reliability of the test.
A: Taking the sample from the outer edge of formed stool is not necessary for a guaiac smear sample.
B: Wearing sterile gloves is important for infection control but not specifically for collecting a guaiac smear sample.
C: Collecting three samples from a single bowel movement is not standard practice for fecal occult blood testing and may not be necessary.
E, F, G: No further options provided.
A nurse is caring for a client who has a contusion of the brainstem and reports thirst. The client's urinary output was 4,000 mL over the past 24 hr. The nurse should anticipate a prescription for which of the following IV medications?
- A. Nitroprusside
- B. Furosemide
- C. Epinephrine
- D. Desmopressin
Correct Answer: D
Rationale: The correct answer is D: Desmopressin. The client with a contusion of the brainstem and increased urinary output of 4,000 mL in 24 hrs is likely experiencing diabetes insipidus (DI), which is characterized by excessive urination and thirst. Desmopressin is a synthetic form of antidiuretic hormone (ADH) that helps reduce urine production and control thirst in DI. Nitroprusside (A) is a vasodilator used to treat hypertensive emergencies, not related to DI. Furosemide (B) is a loop diuretic that increases urine output and would worsen the client's condition. Epinephrine (C) is a sympathomimetic drug used in emergencies like anaphylaxis, not for DI. Therefore, Desmopressin is the most appropriate choice to address the client's symptoms.
A nurse is assessing a client who has increased intracranial pressure. The nurse should recognize that which of the following is the first sign of deteriorating neurological status?
- A. Altered level of consciousness
- B. Cheyne-Stokes respirations
- C. Decorticate posturing
- D. Pupillary dilation
Correct Answer: A
Rationale: The correct answer is A: Altered level of consciousness. This is the first sign of deteriorating neurological status in a client with increased intracranial pressure. Changes in consciousness indicate impairment in brain function, signaling potential brain injury or worsening condition. Altered level of consciousness can progress rapidly if not addressed promptly.
Choice B, Cheyne-Stokes respirations, is associated with abnormal breathing patterns and typically occurs in conditions like heart failure or brain injury, but it is not the first sign of neurological deterioration.
Choice C, Decorticate posturing, is a sign of brain injury but typically occurs after alterations in consciousness.
Choice D, pupillary dilation, can be a sign of increased intracranial pressure, but it usually occurs after alterations in consciousness.
A nurse is preparing to administer daily medications to a client who is undergoing a procedure at 1000 that requires IV contrast dye. Which of the following routine medications to give at 0800 should the nurse withhold?
- A. Fluticasone
- B. Metoprolol
- C. Metformin
- D. Valproic acid
Correct Answer: C
Rationale: The correct answer is C: Metformin. The nurse should withhold metformin before the procedure with IV contrast dye due to the risk of lactic acidosis. IV contrast dye can affect kidney function, leading to an increased risk of lactic acidosis when combined with metformin. Fluticasone (A), metoprolol (B), and valproic acid (D) are not contraindicated before the procedure with IV contrast dye. Fluticasone is an inhaled corticosteroid, metoprolol is a beta-blocker, and valproic acid is an anticonvulsant. These medications are not typically affected by IV contrast dye and can be safely administered.
A nurse is caring for a client who is postoperative and develops respiratory depression after receiving morphine for pain control. Which of the following medications should the nurse expect the provider to prescribe?
- A. Flumazenil
- B. Calcium gluconate
- C. Diphenhydramine
- D. Naloxone
Correct Answer: D
Rationale: The correct answer is D: Naloxone. Naloxone is an opioid antagonist that reverses the effects of opioids, including respiratory depression. Therefore, the nurse should expect the provider to prescribe naloxone to counteract the respiratory depression caused by morphine. Flumazenil (A) is a benzodiazepine antagonist and would not be effective in this situation. Calcium gluconate (B) is used to treat calcium deficiencies and would not address respiratory depression. Diphenhydramine (C) is an antihistamine and not indicated for reversing opioid-induced respiratory depression.