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A patient with rheumatoid arthritis is prescribed methotrexate. What should the nurse include in the patient teaching?
- A. Take folic acid supplements as prescribed.
- B. Avoid alcohol completely.
- C. Expect to see immediate results.
- D. Limit fluid intake to 1 liter per day.
Correct Answer: A
Rationale: The correct answer is A: Take folic acid supplements as prescribed. Methotrexate can lead to folic acid deficiency, so supplementing with folic acid helps prevent side effects. It is important for the nurse to educate the patient on the importance of taking folic acid to maintain overall health.
Choice B is incorrect. While it is generally recommended to limit alcohol consumption with methotrexate, avoiding it completely may not be necessary for all patients.
Choice C is incorrect. Methotrexate takes time to work, often several weeks to months, so immediate results should not be expected.
Choice D is incorrect. Limiting fluid intake to 1 liter per day is not a standard recommendation for patients taking methotrexate. Adequate hydration is important for overall health.
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The community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?
- A. The mother who took her children from school because aliens were after them.
- B. The young man who has a history of substance abuse and no telephone.
- C. The newly diagnosed client who needs to be evaluated for medication compliance.
- D. The young woman who believes she is to blame for her recent miscarriage.
Correct Answer: A
Rationale: The correct answer is A: The mother who took her children from school because aliens were after them should be seen first. This choice indicates potential harm to the children due to the mother's delusions, posing an immediate safety concern. The nurse needs to assess the situation and ensure the children's safety. Choices B, C, and D do not present immediate safety risks. B is a history of substance abuse but no current immediate danger. C is newly diagnosed and can wait for evaluation, as can D who may need support but is not in immediate danger. Prioritizing safety is crucial in mental health nursing.
A patient with severe anemia is prescribed erythropoietin. What is the primary action of this medication?
- A. Stimulate white blood cell production
- B. Increase platelet count
- C. Promote red blood cell production
- D. Enhance clotting factor production
Correct Answer: C
Rationale: The correct answer is C: Promote red blood cell production. Erythropoietin is a hormone that stimulates the bone marrow to produce more red blood cells, helping to treat anemia. It does not stimulate white blood cell production (A), increase platelet count (B), or enhance clotting factor production (D). White blood cells are involved in the immune response, platelets are responsible for clotting, and clotting factors are proteins involved in the blood clotting process. Therefore, the primary action of erythropoietin is to specifically target red blood cell production to address anemia.
A patient with asthma is prescribed a corticosteroid inhaler. What is the most important instruction to give to the patient?
- A. Use the inhaler only during asthma attacks.
- B. Rinse the mouth after using the inhaler.
- C. Take a double dose if symptoms worsen.
- D. Avoid using a spacer with the inhaler.
Correct Answer: B
Rationale: The correct answer is B: Rinse the mouth after using the inhaler. This instruction is crucial because corticosteroid inhalers can lead to oral thrush, a fungal infection in the mouth. Rinsing the mouth helps prevent this side effect.
A: Using the inhaler only during asthma attacks is incorrect as corticosteroid inhalers are typically used regularly to manage asthma symptoms.
C: Taking a double dose if symptoms worsen is dangerous and can lead to overdose. Patients should follow the prescribed dosage.
D: Avoiding using a spacer with the inhaler is not a universal instruction. Spacers can actually improve the effectiveness of the medication delivery.
The community health nurse is working in a multi-ethnic health center. In what situation should the nurse intervene?
- A. An Asian-American mother reports using cupping to treat infection, resulting in a pattern of red round marks on her toddler's back.
- B. A Hispanic pregnant client who is often late for appointments, arrives late for today's appointment.
- C. A Native-American who is being interviewed will not make direct eye contact when asked about violence in the home.
- D. An African-American infant who is spitting up milk has lost 6 ounces since last week's clinic visit.
Correct Answer: D
Rationale: The correct answer is D because an African-American infant losing weight rapidly is a sign of potential malnutrition or health issue that requires immediate intervention. The nurse should assess the infant's feeding, growth, and health status to address the problem promptly.
Choice A is incorrect as cupping is a cultural practice that may not necessarily harm the child and should be respected. Choice B is incorrect as being late for appointments is not a direct health risk that requires immediate intervention. Choice C is incorrect as avoiding direct eye contact is a cultural norm for some Native-American individuals and does not indicate a health emergency.
What side effect should be monitored for in a patient with chronic heart failure taking spironolactone?
- A. Hypokalemia
- B. Hyperkalemia
- C. Hyponatremia
- D. Hypernatremia
Correct Answer: B
Rationale: The correct answer is B: Hyperkalemia. Spironolactone is a potassium-sparing diuretic commonly used in patients with heart failure. It works by blocking the aldosterone receptor, leading to potassium retention and potential hyperkalemia. Monitoring potassium levels is crucial as hyperkalemia can increase the risk of arrhythmias and other cardiac complications in heart failure patients.
A: Hypokalemia is incorrect because spironolactone typically causes potassium retention.
C: Hyponatremia and D: Hypernatremia are incorrect as spironolactone does not directly affect sodium levels.
In summary, monitoring for hyperkalemia is essential in patients with heart failure taking spironolactone to prevent adverse cardiac events.