Nokea
A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?
- A. Breakthrough bleeding
- B. Severe calf pain
- C. Mild headache
- D. Weight gain of 3 lb
Correct Answer: B
Rationale: Severe calf pain may indicate a deep vein thrombosis, a serious complication of oral contraceptives that requires immediate reporting. Breakthrough bleeding, mild headaches, and minor weight gain are less urgent.
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A client with a history of chronic kidney disease is prescribed furosemide (Lasix). The nurse should monitor the client for which of the following electrolyte imbalances? Select all that apply.
- A. Hypokalemia.
- B. Hyponatremia.
- C. Hypomagnesemia.
- D. Hypercalcemia.
- E. Hypophosphatemia.
Correct Answer: A, B, C
Rationale: Furosemide can cause hypokalemia, hyponatremia, and hypomagnesemia due to electrolyte loss.
The nurse is caring for a client with a history of gastric ulcer who is prescribed sucralfate (Carafate). The nurse should instruct the client to take the medication:
- A. With meals to enhance absorption.
- B. On an empty stomach.
- C. At bedtime only.
- D. With an antacid.
Correct Answer: B
Rationale: Sucralfate should be taken on an empty stomach to coat the gastric mucosa effectively, promoting ulcer healing.
The nurse should closely monitor the client with an open fracture for which of the following complications?
- A. Avascular necrosis.
- B. Compartment syndrome.
- C. Osteomyelitis.
- D. Fat embolism syndrome.
Correct Answer: C
Rationale: Open fractures have a high risk of osteomyelitis due to exposure to pathogens.
When you are monitoring your client who is now started on an intravenous antibiotic for an infection, you notice that the client is exhibiting signs of anaphylaxis. What is your first priority intervention?
- A. Stop the intravenous flow
- B. Slow down the intravenous flow
- C. Notify the doctor
- D. Begin CPR
Correct Answer: A
Rationale: Stopping the IV flow immediately halts the administration of the allergen, which is the priority in anaphylaxis.
A client with pancreatitis is admitted with severe abdominal pain. Which position should the nurse encourage to reduce discomfort?
- A. Supine with legs elevated
- B. Side-lying with knees flexed
- C. Prone with a pillow under the abdomen
- D. Sitting upright
Correct Answer: B
Rationale: Side-lying with knees flexed reduces tension on the abdominal muscles and pancreas, helping to alleviate pain in pancreatitis.