Nokea
A patient in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system to manage asthma. This system delivers an inhaled powdered form of these combined medications. What instruction should the nurse provide to this patient’s caregivers?
- A. Instruct the patient to exhale rapidly into the mouthpiece when using the discus.
- B. Explain that the patient should not use the discus more than twice daily.
- C. Inform that patients using the discus may experience a decrease in blood pressure.
- D. Suggest offering the discus to the patient for use during an acute asthma attack.
Correct Answer: B
Rationale: Fluticasone/salmeterol is a maintenance therapy, used twice daily (B). Exhaling into the mouthpiece (A) is incorrect; inhalation is required. Hypotension (C) isn’t a common side effect. It’s not for acute attacks (D), which require rescue inhalers.
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A patient is receiving a secondary infusion of azithromycin 500 mg in 500 mL of normal saline (NS) to be infused over 2 hours. The intravenous (IV) administration set delivers 10 gtt/mL. How many gtt/min should the nurse regulate the infusion?
Correct Answer: 42
Rationale: Infusion rate: 500 mL / 2 hr = 250 mL/hr. Drops per minute: (250 mL/hr × 10 gtt/mL) / 60 min = 41.67, rounded to 42 gtt/min. This ensures accurate delivery of azithromycin.
A patient with chemotherapy-induced nausea has been prescribed metoclopramide. What adverse effect should the nurse report?
- A. Diarrhea.
- B. Unusual irritability.
- C. Nausea.
- D. Involuntary movements.
Correct Answer: D
Rationale: This question is identical to Question 5. Involuntary movements (D), such as tardive dyskinesia, are a serious metoclopramide side effect, requiring immediate reporting. Diarrhea (A) and irritability (B) are less severe. Nausea (C) is the treated condition. Note: Duplicate question; consider removing.
An elderly client with heart failure arrives at the emergency room due to nausea, vomiting, and anorexia. Based on the client’s signs and symptoms, which piece of data from the medical history is most significant when planning this client’s care?
- A. The client underwent a coronary artery bypass procedure in 1995.
- B. The client had a colonoscopy performed for routine screening six months ago.
- C. The client suffered from depression following the death of their spouse in 1999.
- D. The client has been taking digoxin and furosemide daily since 1996.
Correct Answer: D
Rationale: Digoxin and furosemide (D) can cause nausea, vomiting, and anorexia due to toxicity (digoxin) or electrolyte imbalances (furosemide), critical for heart failure management. Past bypass (A), colonoscopy (B), and depression (C) are less relevant to current symptoms.
The nurse is preparing to administer a scheduled dose of labetalol orally to a client with hypertension. The client’s vital signs are temperature 99° F (37.2 C), heart rate 48 beats/minute, respirations 16 breaths/minute, and blood pressure (BP) 150/90 mm Hg. What action should the nurse take?
- A. Withhold the scheduled dose and notify the healthcare provider.
- B. Administer the dose and monitor the client’s BP regularly.
- C. Assess for orthostatic hypotension before administering the dose.
- D. Apply a telemetry monitor before administering the dose.
Correct Answer: A
Rationale: Labetalol, a beta-blocker, can worsen bradycardia (heart rate 48 bpm). Withholding the dose and notifying the provider (A) is safest. Administering (B) risks exacerbating bradycardia. Orthostatic hypotension assessment (C) and telemetry (D) are secondary.
A client with psychosis is receiving an antipsychotic medication and is continually rubbing the back of the neck. What is the best nursing intervention?
- A. Obtain an extra pillow for the client to use at night.
- B. Give a PRN prescription for benztropine.
- C. Provide the client a heating pad to place on the neck.
- D. Obtain a prescription for physical therapy services.
Correct Answer: B
Rationale: Neck rubbing suggests extrapyramidal symptoms (e.g., dystonia) from antipsychotics. Benztropine (B), an anticholinergic, relieves these symptoms. Pillows (A), heating pads (C), and physical therapy (D) don’t address the cause.