A patient has recently been prescribed Albuterol. Which of the following changes are not associated with Albuterol?
- A. Tachycardia
- B. Hypertension
- C. Bronchodilation
- D. Sensory changes
Correct Answer: D
Rationale: Tachycardia, hypertension, and bronchodilation can all occur with Albuterol.
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A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility. The nurse notices on assessment that an area over the patient's left elbow appears as non-blanchable erythema and the skin is intact. The nurse should score the patient as having which of the following?
- A. Stage I pressure ulcer
- B. Stage II pressure ulcer
- C. Stage III pressure ulcer
- D. Stage IV pressure ulcer
Correct Answer: A
Rationale: Erythema with the skin intact can indicate a Stage I pressure ulcer.
Which of the following solutions is routinely used to flush an IV device before and after the administration of blood to a client?
- A. 0.9% sodium chloride
- B. 5% dextrose in water solution
- C. sterile water
- D. Heparin sodium
Correct Answer: A
Rationale: Normal saline (0.9% sodium chloride) is isotonic and safe for flushing IV lines before and after blood administration, preventing cell lysis or clotting.
A client and his family facing the end stage of a terminal illness might be best served by:
- A. a rehabilitation center.
- B. an extended care facility.
- C. Hospice.
- D. a crisis intervention center.
Correct Answer: C
Rationale: Hospice has the belief that more humanized alternative care for dying clients is needed than is being provided in hospitals, which focus mostly on medical cures. No matter where the care is delivered, Hospice provides a specialized interdisciplinary team of health care professionals who work together to manage client care.
To improve overall health, the nurse should place highest priority on assisting a client to make lifestyle changes for which of the following habits?
- A. Drinking a six-pack of beer each day
- B. Eating an occasional chocolate bar
- C. Exercising twice a week
- D. Using relaxation exercises to deal with stress
Correct Answer: A
Rationale: Daily heavy alcohol consumption poses significant health risks (liver disease, cardiovascular issues), making it the highest priority for lifestyle change.
Who should receive the hepatitis A vaccine?
- A. children who are 18 months of age
- B. infants, who should receive the vaccination at birth
- C. people who travel to other countries
- D. individuals who might come into contact with blood
Correct Answer: C
Rationale: Hepatitis A is for individuals who travel or persons with chronic liver disease. Infants receive the hepatitis B vaccine at birth. DTaP is administered at 18 months of age. Individuals who come into contact with blood should be immunized against hepatitis B.
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