After securing the client's safety from a faulty electric bed, the nurse should take which action?
- A. Discuss the matter with the client's significant others.
- B. Document the incident in the client's record in detail.
- C. Notify the physician.
- D. Prepare an incident report.
Correct Answer: D
Rationale: After the situation is safe for the client, the nurse should record the occurrence on an incident form according to the agency protocol.
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A client taking isotretinoin (Accutane) tells the nurse that she is pregnant. What should the nurse teach this client?
- A. Her pregnancy is threatened, and the fetus is at risk for teratogenesis.
- B. She has a reportable condition, and the pregnancy must be terminated.
- C. Accutane is a Category D drug, which means it is unsafe in pregnancy.
- D. Her pregnancy must be followed carefully by a genetic specialist.
Correct Answer: A
Rationale: Accutane is a Category X drug, which means pregnancy is contraindicated due to teratogenesis associated with the medication.
Acyclovir (Zovirax) is the agent of choice for which of the following infections?
- A. HIV
- B. AIDS
- C. candida
- D. herpes
Correct Answer: D
Rationale: Acyclovir is an antiviral effective in shortening the duration of infection in herpes. It is used in HIV and AIDS to treat opportunistic viral infections but is not a primary AIDS drug. Candida is a fungus responsive to antifungal medication.
The mother calls the nurse to ask when her newborn will be brought back to her room to finish feeding. The mother states that a doctor came about 30 minutes ago to take the baby for an examination and has not returned with her baby. Which action should be taken by the nurse first?
- A. Check the unit for the infant
- B. Initiate procedures for possible newborn abduction
- C. Ask other staff if they saw any physicians on the unit
- D. Check to see if the doctor is still examining the Infant
Correct Answer: B
Rationale: The suspicious circumstance of a doctor taking the baby for 30 minutes warrants immediate initiation of abduction procedures to ensure the newborn's safety.
When an infant car seat is properly installed, the infant should face
- A. forward, so child may look out window
- B. backward, so child faces the seat
- C. the side window, to increase urinary stimulation
- D. upward, as child lies on back with seat installed sideways
Correct Answer: B
Rationale: Infants should be positioned reclining and facing the rear until their leg muscles are strong enough to kick away from the backseat (about 10-12 months-old) for the greatest protection.
The client with a right femoral arterial line is confused, thrashing about in bed, and picking at the tubing. The HCP prescribes wrist restraints. Based on this information, what should the nurse plan to do?
- A. Apply the wrist restraints as prescribed
- B. Request an order for a right ankle restraint also
- C. Request an order for sedation instead of restraints
- D. Question the order; restraints will increase the client's agitation
Correct Answer: B
Rationale: An ankle restraint is needed to prevent leg movement that could dislodge the femoral arterial line, which wrist restraints alone cannot address.
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