Nokea
Allopurinol has been prescribed for a client to treat gouty arthritis. The nurse teaches the client to anticipate which prescription if an acute attack occurs?
- A. Doubling the dose of the allopurinol
- B. Stopping the allopurinol and taking acetylsalicylic acid (aspirin)
- C. Stopping the allopurinol and taking a nonsteroidal anti-inflammatory drug
- D. Adding colchicine or a nonsteroidal anti-inflammatory drug to the treatment plan
Correct Answer: D
Rationale: Allopurinol helps prevent an attack of gouty arthritis, but it does not relieve the pain. Therefore, another medication such as colchicine or a nonsteroidal anti-inflammatory drug must be added if an acute attack occurs. Because acute attacks may occur more frequently early during the course of therapy with allopurinol, some health care providers recommend taking the two products concurrently during the first 3 to 6 months.
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The community health nurse teaches a group of females how to prevent pelvic inflammatory disease (PID). What instruction should the nurse include?
- A. To douche monthly
- B. To avoid unprotected intercourse
- C. To use only ultra-low dose oral contraceptive pills
- D. To consult with a gynecologist regarding the placement of an intrauterine device (IUD)
Correct Answer: B
Rationale: PID is an infection of the pelvis. The primary prevention of PID includes avoiding unprotected intercourse. Douching leads to a higher risk for PID. It is believed that high hormonal doses may decrease risk of PID, but ultra-low doses will not. The use of an IUD may also increase the risk for PID.
The nurse assesses cranial nerve XII in the client who sustained a stroke. Which action should the nurse ask the client to perform?
- A. Extend the arms.
- B. Extend the tongue.
- C. Turn the head toward the nurse's arm.
- D. Focus the eyes on an object held by the nurse.
Correct Answer: B
Rationale: Cranial nerve XII (hypoglossal) controls tongue movement, so extending the tongue tests its function. Other actions test different nerves or motor functions, not relevant to cranial nerve XII.
A client being discharged from the hospital will be taking warfarin sodium at home on a daily basis. The nurse has provided instructions to the client about the medication and determines that further teaching is needed if the client makes which statement?
- A. I need to have a prothrombin time checked in 2 weeks.
- B. This medicine thins my blood and allows me to clot more slowly.
- C. I need to increase the intake of foods high in vitamin K in my diet.
- D. I need to report any increased bleeding or bruising to my doctor.
Correct Answer: C
Rationale: Warfarin sodium is an oral anticoagulant that is used mainly to prevent thrombotic events, such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation or other disorders. Oral anticoagulants prolong the clotting time and are monitored by the prothrombin time and the international normalized ratio (INR). Client education should include signs and symptoms of adverse effects and dietary limitations such as limiting foods high in vitamin K (e.g., leafy green vegetables, liver, cheese, egg yolks) as prescribed because these increase clotting times.
The camp nurse provides instructions regarding skin protection from the sun to the parents who are preparing their children for a camping adventure. Which statement by a parent indicates a need for further instructions?
- A. A protective sunscreen is best to prevent sunburn.
- B. My child won't need the sunscreen on cloudy, hazy days.
- C. I need to pack a hat, long-sleeved shirts, and long pants for my child to wear.
- D. My child should wear clothes that have a tightly woven material for greater protection from the sun's rays.
Correct Answer: B
Rationale: The sun's rays are as damaging to the skin on cloudy, hazy days as they are on sunny days. Sunscreens are recommended and should be applied before exposure to the sun and reapplied frequently and liberally at least every 2 hours. A hat, long-sleeved shirt, and long pants should be worn when out in the sun. Tightly woven materials provide greater protection from the sun's rays.
A mother brings her 6-month-old child to the clinic for a wellness checkup. The nurse anticipates that the health care provider will order which vaccinations for this client?
- A. DTaP and MMR
- B. Hib and varicella
- C. hepatitis B and DTaP
- D. hepatitis A and MMR
Correct Answer: C
Rationale: At 6 months, hepatitis B and DTaP are scheduled. MMR, varicella, and hepatitis A are given later (12-15 months).