Nokea
An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer?
- A. Corticosteroids
- B. Gamma globulin
- C. Hepatitis B vaccine
- D. Fresh frozen plasma
Correct Answer: B
Rationale: The correct answer is B: Gamma globulin. Gamma globulin contains antibodies that can provide immediate passive immunity against hepatitis B virus. Administering corticosteroids (A) would not protect against hepatitis B infection. Hepatitis B vaccine (C) is used for prevention, not immediate protection. Fresh frozen plasma (D) does not contain specific antibodies against hepatitis B.
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A patient with a myocardial infarction (MI) is being treated with intravenous morphine. What is the primary reason for administering morphine to this patient?
- A. To reduce pain.
- B. To decrease anxiety.
- C. To reduce cardiac workload.
- D. To increase respiratory rate.
Correct Answer: C
Rationale: The primary reason for administering morphine to a patient with MI is to reduce cardiac workload. Morphine acts as a vasodilator and decreases preload and afterload on the heart, reducing myocardial oxygen demand. This helps to improve coronary blood flow and decrease the workload on the heart muscle, which is crucial in the setting of an MI.
Explanation for other choices:
A: While morphine can help reduce pain in MI, the primary reason for administering it is to reduce cardiac workload.
B: Morphine may have a calming effect, but the primary goal is to reduce cardiac workload.
D: Morphine can actually decrease respiratory rate as a side effect, making this choice incorrect.
The nurse is administering sevelamer (RenaGel) during lunch to a client with end-stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals?
- A. Prevents indigestion associated with the ingestion of spicy foods.
- B. Binds with phosphorus in foods and prevents absorption.
- C. Promotes stomach emptying and prevents gastric reflux.
- D. Buffers hydrochloric acid and prevents gastric erosion.
Correct Answer: B
Rationale: The correct answer is B: Binds with phosphorus in foods and prevents absorption. Sevelamer (RenaGel) is a phosphate binder used in ESRD to reduce phosphorus levels. Taking it with meals allows it to bind with phosphorus in food, preventing its absorption in the gastrointestinal tract. This helps in controlling hyperphosphatemia, a common complication in ESRD. Choices A, C, and D are incorrect as RenaGel does not prevent indigestion, promote stomach emptying, or buffer hydrochloric acid.
Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?
- A. Continue taking warfarin until the day of surgery.
- B. Stop taking warfarin three days before surgery.
- C. Switch to aspirin before surgery.
- D. Stop taking warfarin one week before surgery.
Correct Answer: D
Rationale: The correct answer is D because stopping warfarin one week before surgery reduces the risk of excessive bleeding during the procedure. Warfarin's anticoagulant effect can persist for several days, so stopping it earlier allows time for its effects to diminish. Choice A is incorrect because continuing warfarin until the day of surgery increases bleeding risk. Choice B is incorrect as stopping warfarin only three days before surgery may not provide enough time for the anticoagulant effect to wear off. Choice C is incorrect as aspirin is not a suitable substitute for warfarin in most cases.
A client with cirrhosis is at risk for bleeding. Which laboratory test is most important to monitor?
- A. Blood glucose
- B. Serum creatinine
- C. Prothrombin time (PT)
- D. Electrolytes
Correct Answer: C
Rationale: The correct answer is C: Prothrombin time (PT). In cirrhosis, the liver's ability to produce clotting factors is impaired, leading to a higher risk of bleeding. Monitoring PT helps assess the liver's synthetic function and the blood's ability to clot. Abnormal PT values indicate a higher bleeding risk and guide interventions like vitamin K or blood products. Blood glucose (A), serum creatinine (B), and electrolytes (D) do not directly reflect the liver's synthetic function or clotting status in cirrhosis, making them less relevant for monitoring bleeding risk.
The patient admitted with diabetic ketoacidosis has rapid, deep respirations. What action should the nurse take?
- A. Administer the prescribed PRN lorazepam (Ativan).
- B. Start the prescribed PRN oxygen at 2 to 4 L/min.
- C. Administer the prescribed normal saline bolus and insulin.
- D. Encourage the patient to practice guided imagery for relaxation.
Correct Answer: C
Rationale: The correct answer is C, administer the prescribed normal saline bolus and insulin. In diabetic ketoacidosis, rapid, deep respirations, known as Kussmaul breathing, occur due to compensatory mechanisms to lower blood pH. Normal saline bolus helps correct dehydration and insulin therapy helps lower blood sugar levels, leading to improved acidosis. Option A is incorrect as lorazepam does not address the underlying cause of the rapid respirations. Option B is incorrect as oxygen is not the priority in this situation. Option D is incorrect as guided imagery does not address the physiological needs of the patient in this critical condition.