Nokea
A primary health care provider has written a prescription to administer methylergonovine maleate to a postpartum client. The nurse should contact the primary health care provider to verify the prescription if which condition is present in the mother?
- A. Hypertension
- B. Excessive lochia
- C. Difficulty locating the uterine fundus
- D. Excessive bleeding and saturation of more than one peripad per hour
Correct Answer: A
Rationale: Methylergonovine maleate is an ergot alkaloid used to treat uterine atony. It is contraindicated for the hypertensive woman, individuals with severe hepatic or renal disease, and during the third stage of labor. Excessive lochia, a uterine fundus that is difficult to locate, and excessive bleeding are clinical manifestations of uterine atony indicating the need for methylergonovine.
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The nurse is preparing the bedside for a postoperative parathyroidectomy client. The nurse should ensure that which specific priority item is at the client's bedside?
- A. Cardiac monitor
- B. Tracheotomy set
- C. Intermittent gastric suction
- D. Underwater seal chest drainage system
Correct Answer: B
Rationale: Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a primary concern for the nurse managing the care of a postoperative parathyroidectomy client. An emergency tracheotomy set is always routinely placed at the bedside of the client with this type of surgery, in anticipation of this potential complication. Although a cardiac monitor may be attached to the client in the postoperative period, it is not specific to this type of surgery. Options 3 and 4 also are not specifically needed with the surgical procedure.
A new nurse is learning the functions of the unit's nurse manager. Which functions are included? Select all that apply.
- A. Recruiting new employees
- B. Conducting regular staff meetings
- C. Assisting staff in meeting annual goals
- D. Monitoring professional standards of practice on the nursing unit
- E. Delegating problem-solving of client or family complaints to all nursing staff
- F. Writing prescriptions for primary health care providers (HCPs) when conducting rounds
Correct Answer: A,B,C,D
Rationale: Responsibilities of the nurse manager (middle manager) include recruiting new employees (interviewing and hiring), conducting regular staff meetings, assisting staff in meeting annual goals for the unit and systems needed to accomplish goals, monitoring professional standards of practice on the nursing unit, developing an ongoing staff development plan, conducting routine staff evaluations, acting as a role model, submitting staff schedules for the unit, conducting regular client rounds and problem-solving client and family complaints, establishing and implementing a unit quality improvement plan, and conducting rounds with primary HCPs. The nurse is not responsible for writing prescriptions for HCPs when conducting rounds; the HCP is responsible for writing prescriptions.
A primary health care provider prescribes 1000 mL of 0.45% normal saline solution to run over 8 hours. The drop factor is 15 drops/mL. The nurse plans to adjust the flow rate to how many drops per minute to safely administer this intravenous (IV) solution? Fill in the blank and round answer to the nearest whole number.
Correct Answer: 31
Rationale: The prescribed 1000 mL is to be infused over 8 hours. Follow the formula for calculating IV flow rates and multiply 1000 mL by 15 (drop factor). Then divide the result by 480 minutes (8 hours × 60 minutes). The infusion is to run at 31.2 or 31 drops/min.
The nurse employed in a home health agency is religiously opposed to homosexuality and cannot care for a client diagnosed with human immunodeficiency virus (HIV). The nurse then leaves the client's home. Which statement accurately identifies the nurse's rights and actions? Select all that apply.
- A. The nurse has the moral right to leave the client's home at any time.
- B. The nurse has a legal right to inform the client of any barriers to providing care.
- C. The nurse has a duty to protect self from client care situations that are morally repellent.
- D. The nurse has a duty to provide competent care to assigned clients in a nondiscriminatory manner.
- E. The nurse has the right to refuse to care for any client on religious grounds if competent care coverage is arranged.
Correct Answer: D,E
Rationale: The nurse has a duty to provide care to all clients in a nondiscriminatory manner. Personal autonomy does not apply if it interferes with the rights of the client. Refusal to provide care may be acceptable if that refusal does not put the client's safety at risk and the refusal is primarily associated with religious objections, not personal objection, to lifestyle or medical diagnosis. There is no legal obligation to inform the client of the nurse's personal objections to the client. The nurse also has an obligation to observe the principle of nonmaleficence (neither causing nor allowing harm to befall the client).
Which findings documented in the history of an older client should require the nurse to implement an accident prevention protocol? Select all that apply.
- A. Range of motion is limited.
- B. Peripheral vision is decreased.
- C. Transmission of hot impulses is delayed.
- D. The client reports incidences of nocturia.
- E. High-frequency hearing tones are perceptible.
- F. Voluntary and autonomic reflexes are slowed.
Correct Answer: A,B,C,D,F
Rationale: The physiological changes that occur during the aging process increase the client's risk for accidents. Musculoskeletal changes include a decrease in muscle strength and function, lessened joint mobility, and limited range of motion. Sensory changes include a decrease in peripheral vision and lens accommodation, delayed transmission of hot and cold impulses, and impaired hearing as high-frequency tones become less perceptible. Nervous system changes include slowed voluntary and autonomic reflexes. Genitourinary changes may include nocturia.