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After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
- A. I will avoid large crowds and people who are sick.
- B. I will take this medication with my breakfast each morning.
- C. Nausea and vomiting are common side effects of this drug.
- D. I must wash my hands after I play with my dog.
Correct Answer: B
Rationale: Adalimumab (Humira) is administered via subcutaneous injection, not orally with meals. Avoiding crowds and sick individuals, recognizing nausea and vomiting as side effects, and practicing good hand hygiene are correct actions, as adalimumab causes immune suppression.
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A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy supplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client? (Record your answer using a whole number)
- A. 20 mL
- B. 25 mL
- C. 30 mL
- D. 35 mL
Correct Answer: B
Rationale: The client weighs 110 lbs (50 kg). The dose is 5 mg/kg, so 5 mg/kg ? 50 kg = 250 mg. The pharmacy supplies 100 mg/10 mL, so 250 mg ÷ 100 mg/10 mL = 25 mL.
A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find?
- A. A severe steady right lower quadrant pain.
- B. Abdominal pain associated with nausea and vomiting
- C. Marked peristalsis and hyperactive bowel sounds.
- D. Abdominal pain that increases with knee flexion
Correct Answer: A
Rationale: Right lower quadrant pain, specifically at McBurney's point, is characteristic of appendicitis. Nausea and vomiting typically indicate gastroenteritis if they occur first. Marked peristalsis and hyperactive bowel sounds are not typical of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion.
After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
- A. I must clean my rectal area with warm water after each stool and apply zinc oxide ointment.
- B. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel.
- C. I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry.
- D. I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment.
Correct Answer: B
Rationale: Toilet paper can irritate sensitive perineal skin, so warm water rinses or a soft cotton washcloth should be used instead. Aloe vera is not effective for protecting skin from the excoriating effects of liquid stools. The other options describe appropriate care to prevent further irritation.
After teaching a client with an anal fissure, a nurse assesses the client's understanding. Which client actions indicate that the client correctly understands the teaching? (Select all that apply.)
- A. Taking a warm sitz bath several times each day
- B. Utilizing a daily enema to prevent constipation
- C. Using bulk-producing agents to aid elimination
- D. Taking a laxative each morning
- E. Using anti-inflammatory suppositories
Correct Answer: A,C,E
Rationale: Warm sitz baths, bulk-producing agents (e.g., psyllium), and anti-inflammatory suppositories help manage anal fissures by reducing irritation, promoting soft stools, and decreasing inflammation. Daily enemas and morning laxatives are not recommended, as they may cause dependency or irritation.
A nurse assesses a client with Crohn's disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider?
- A. Distended abdomen
- B. Temperature of 100.0°F (37.8°C)
- C. Loose and bloody stool
- D. Abdominal cramps
Correct Answer: A
Rationale: Colonic strictures predispose the client to intestinal obstruction. A distended abdomen may indicate an obstruction, requiring urgent notification of the provider. Low-grade fever, loose and bloody stools, and abdominal cramps are common symptoms of Crohn's disease and do not require immediate intervention.