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After an older client receives treatment for drug toxicity, the healthcare provider prescribes a 24-hour creatinine clearance test. Before starting the urine collection, the nurse noted that the client's serum creatinine was 0.3 mg/dL. Which action should the nurse implement?
- A. Check the client's urine output hourly
- B. Instruct the client to increase fluid intake
- C. Notify the healthcare provider of the results
- D. Start the 24-hour urine collection
Correct Answer: C
Rationale: A serum creatinine level of 0.3 mg/dL is abnormally low, indicating potential issues with the interpretation of the creatinine clearance test. It is crucial for the nurse to notify the healthcare provider of this result before proceeding with the 24-hour urine collection. Checking urine output, instructing the client to increase fluid intake, or starting the urine collection without consulting the healthcare provider could lead to incorrect test results and misinterpretation of the client's renal function.
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A client is diagnosed with tuberculosis and is placed on isoniazid (INH) and rifampin (Rifadin). The nurse should emphasize the importance of
- A. Daily use of a bronchodilator
- B. The importance of taking medication as prescribed
- C. Decreasing salt intake
- D. Avoidance of direct sunlight
Correct Answer: B
Rationale: The correct answer is B: The importance of taking medication as prescribed. In the treatment of tuberculosis, adherence to the prescribed medication regimen is crucial to effectively manage the infection and prevent the development of drug resistance. Choices A, C, and D are incorrect because bronchodilators, salt intake, and sunlight exposure are not directly related to the treatment of tuberculosis with isoniazid and rifampin.
Prior to surgery, written consent must be obtained. What is the nurse's legal responsibility with regard to obtaining written consent?
- A. Witness the consent and sign the form as a witness
- B. Inform the client of alternatives to the procedure
- C. Explain the procedure in detail to the client
- D. Determine that the surgical consent form has been signed and is included in the client's record
Correct Answer: D
Rationale: The nurse's legal responsibility is to ensure that informed consent has been obtained by verifying that the client has signed the form and that it is included in the record. Witnessing the consent and signing as a witness is not the nurse's role, as this is typically done by a neutral party. Informing the client of alternatives to the procedure and explaining the procedure in detail are responsibilities of the healthcare provider performing the surgery, not the nurse.
A client receiving chemotherapy reports severe nausea. What should the nurse implement first?
- A. Administer an antiemetic as prescribed.
- B. Offer the client small, frequent meals.
- C. Provide the client with crackers and water.
- D. Encourage the client to eat a bland diet.
Correct Answer: A
Rationale: The correct answer is A: Administer an antiemetic as prescribed. When a client receiving chemotherapy reports severe nausea, the priority action is to administer an antiemetic medication as prescribed. Antiemetics help alleviate nausea and prevent complications associated with chemotherapy, such as dehydration and malnutrition. Options B, C, and D focus on dietary interventions which can be helpful but addressing the severe nausea with antiemetic medication takes precedence to provide immediate relief and ensure the client's comfort and well-being.
A client with a urinary tract infection (UTI) is prescribed antibiotics. What is the most important instruction for the nurse to give the client?
- A. Take the antibiotics with food
- B. Complete the full course of antibiotics
- C. Increase fluid intake to at least 2 liters per day
- D. Take over-the-counter pain relievers for discomfort
Correct Answer: B
Rationale: The most crucial instruction for the nurse to give a client with a UTI who is prescribed antibiotics is to complete the full course of antibiotics. Completing the full course of antibiotics is essential to ensure that the infection is fully treated and to prevent the development of antibiotic resistance. While taking antibiotics with food, increasing fluid intake, and managing discomfort with pain relievers are important aspects of UTI management, completing the prescribed course of antibiotics is the top priority to achieve the best treatment outcomes and prevent recurrence of the infection.
A 30-year-old male client reports difficulty sleeping due to anxiety about his upcoming surgery. What intervention would be most appropriate for the nurse to suggest?
- A. Suggest taking a mild sedative before bed.
- B. Encourage physical activity before bedtime.
- C. Advise listening to calming music before bed.
- D. Recommend reading a book before bed.
Correct Answer: A
Rationale: The most appropriate intervention for the nurse to suggest to a 30-year-old male client experiencing difficulty sleeping due to anxiety about his upcoming surgery is to recommend taking a mild sedative before bed. A mild sedative can help manage anxiety and improve sleep in such situations. Encouraging physical activity before bedtime, advising to listen to calming music, or recommending reading a book may not directly address the client's anxiety and may not be as effective in promoting sleep in this scenario.