Nokea
After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching?
- A. I will take my vitamins while I'm on this drug.'
- B. I must not drink any alcohol while I'm taking this drug.'
- C. I should brush my teeth after every meal.'
- D. I will continue taking my birth control pills.'
Correct Answer: A
Rationale: Methotrexate can interact with certain vitamins (e.g., folic acid) if not prescribed, requiring medical guidance. The other statements align with safe methotrexate use.
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Which of the following is a risk factor for hypovolemic shock?
- A. Hemorrhage.
- B. Antigen-antibody reaction.
- C. Gram-negative bacteria.
- D. Vasodilation.
Correct Answer: A
Rationale: Hemorrhage is a primary cause of hypovolemic shock, as it reduces circulating blood volume. Antigen-antibody reactions cause anaphylactic shock, gram-negative bacteria cause septic shock, and vasodilation is a feature of distributive shock.
Which of the following is contraindicated for a client diagnosed with disseminated intravascular coagulation (DIC)?
- A. Treating the underlying cause.
- B. Administering heparin.
- C. Administering warfarin sodium (Coumadin).
- D. Replacing depleted blood products.
Correct Answer: C
Rationale: Warfarin is contraindicated in DIC because it further inhibits clotting factors, worsening bleeding. Treating the underlying cause, administering heparin (to stop clotting), and replacing blood products are standard treatments to manage DIC.
A client at risk for lung cancer asks why he is scheduled for a computed tomography (CT) scan as part of his initial workup. The nurse's best response is which of the following?
- A. CT is far superior to magnetic resonance imaging for evaluating lymph node metastasis.
- B. CT is noninvasive and readily available.
- C. CT is useful for distinguishing small differences in tissue density and detecting nodal involvement.
- D. CT can distinguish a malignant from a nonmalignant adenopathy.
Correct Answer: C
Rationale: CT scans are valuable in lung cancer workups because they can detect small differences in tissue density and identify nodal involvement, aiding in staging and diagnosis.
The nurse is reviewing the chart information for a client with increased ascites. The data include: temperature 37.2°C; heart rate 118; shallow respirations 26; blood pressure 128/76; and SpO2 89% on room air. Which action should receive priority by the nurse?
- A. Assess heart sounds.
- B. Obtain an order for blood cultures.
- C. Prepare for a paracentesis.
- D. Raise the head of the bed.
Correct Answer: D
Rationale: Low SpO2 (89%) and shallow respirations indicate respiratory compromise, likely from ascites pressing on the diaphragm. Raising the head of the bed (D) improves breathing. Heart sounds (A), blood cultures (B), and paracentesis (C) are secondary.
A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question?
- A. Call for urine output <30 mL/hour for 2 consecutive hours.
- B. Metoprolol (Lopressor) 5 mg I.V. push.
- C. Symptom for a pulmonary artery catheter insertion.
- D. Titrate Dobutamine (Dobutrex) to keep systolic BP >100.
Correct Answer: B
Rationale: Metoprolol, a beta-blocker, can worsen cardiogenic shock by reducing heart rate and contractility. Other orders are appropriate for monitoring and supporting perfusion in cardiogenic shock.