A patient refuses to take his dose of oral medication. The nurse tells the patient that if he does not take the medication that she will administer it by injection. The nurse's comments can result in a charge of:
- A. Malpractice
- B. Assault
- C. Negligence
- D. Battery
Correct Answer: B
Rationale: Threatening to administer medication by injection against the patient's will constitutes assault, as it involves a threat of unwanted contact.
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The nurse assesses a new order for a blood transfusion. The order is to transfuse 1 unit of packed red blood cells (contains 250 mL) in a 2-hour period. What will be the hourly rate of infusion?
- A. 50 mL/hr
- B. 62 mL/hr
- C. 125 mL/hr
- D. 137 mL/hr
Correct Answer: C
Rationale: To calculate the hourly rate: 250 mL ÷ 2 hours = 125 mL/hr, ensuring the transfusion is completed within the prescribed time.
A client in the cardiac step-down unit requires suctioning for excess mucous secretions. The dysrhythmia most commonly seen during suctioning is:
- A. Bradycardia
- B. Tachycardia
- C. Premature ventricular beats
- D. Heart block
Correct Answer: A
Rationale: Suctioning can stimulate the vagus nerve, leading to bradycardia due to parasympathetic activation.
A new graduate nurse completes her first full shift with her preceptor. It was a long, overwhelming day and the new nurse takes a deep breath and says to herself, 'You can do this! Nursing will be a challenge but you are up for it and tomorrow is a new day.' This type of communication is
- A. intrapersonal.
- B. horizontal.
- C. interpersonal.
- D. vertical.
Correct Answer: A
Rationale: Intrapersonal communication is self-talk, as the nurse reflects and motivates herself.
The client is having fetal heart rates of 100-110 beats per minute during the contractions. The first action the nurse should take is to:
- A. Apply an internal monitor
- B. Turn the client to her side
- C. Get the client up and walk her in the hall
- D. Move the client to the delivery room
Correct Answer: B
Rationale: Turning the client to her side improves uteroplacental perfusion, addressing fetal bradycardia during contractions.
The doctor has prescribed Claratin (loratidine) for a client with seasonal allergies. The feature that separates Claratin from other antihistamines such as diphenhydramine is that the medication:
- A. Is nonsedating
- B. Stimulates appetite
- C. Is used for motion sickness
- D. Is less expensive
Correct Answer: A
Rationale: Loratadine (Claritin) is a second-generation antihistamine that is nonsedating, unlike first-generation antihistamines like diphenhydramine.
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