Nokea
An adult client has rheumatoid arthritis. Aspirin 975 mg q4h PRN is ordered for pain. At 2:00 P.M., the client requests pain medication. Aspirin was last given at 9:30 A.M. What is the most appropriate initial action for the nurse to take?
- A. Give the aspirin as ordered
- B. Question the order because it is a higher than normal dosage
- C. Attempt to divert the client's attention from the pain
- D. Assess the nature of the pain
Correct Answer: A
Rationale: The time since the last dose (4.5 hours) is within the q4h PRN order, and 975 mg is a standard high dose for rheumatoid arthritis.
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The client with postmenopausal osteoporosis is prescribed the bisphosphonate alendronate (Fosamax). Which discharge instruction should the nurse discuss with the client?
- A. The medication must be taken with the breakfast meal only.
- B. Remain upright for at least 30 minutes after taking medication.
- C. The tablet should be chewed thoroughly before swallowing.
- D. Stress the importance of having monthly hormone levels.
Correct Answer: B
Rationale: Alendronate requires upright posture for 30 minutes post-dose to prevent esophageal irritation, per FDA guidelines. Meal timing, chewing, or hormone levels are incorrect.
A woman who is receiving cancer chemotherapy exhibits all of the following. Which is most indicative of bone marrow depression?
- A. Alopecia
- B. Petechiae
- C. Stomatitis
- D. Constipation
Correct Answer: B
Rationale: Petechiae indicate low platelets, a sign of bone marrow depression, a common chemotherapy side effect.
The client with type 2 diabetes mellitus is prescribed glyburide (Micronase), a sulfonylurea. Which statement indicates the client understands the medication teaching?
- A. I should carry some hard candy when I go walking.
- B. I must take my insulin injection every morning.
- C. There are no side effects I need to worry about.
- D. This medication will make my muscles absorb insulin.
Correct Answer: A
Rationale: Glyburide can cause hypoglycemia; carrying candy prepares for low blood sugar during activity. Insulin, no side effects, or muscle absorption are incorrect.
The nurse is preparing to administer 37.5 mg of meperidine (Demerol) IM to a client who is having pain. The medication comes in a 50-mg/mL vial. Which action should the nurse implement?
- A. Notify the pharmacist to bring the correct vial.
- B. Have another nurse verify wastage of medication.
- C. Administer one (1) mL of medication to the client.
- D. Request the HCP to increase the client's dose.
Correct Answer: B
Rationale: Dose: 37.5 mg / 50 mg/mL = 0.75 mL. Wasting 0.25 mL requires verification by another nurse, per narcotic protocols.
A nurse who has been named in a lawsuit can use which of these factors for the best protection in a court of law?
- A. Clinical specialty certification in the associated area of practice
- B. Documentation on the specific client record with a focus on the nursing process
- C. Yearly evaluations and proficiency reports prepared by nurse's manager
- D. Verification of provider's orders for the plan of care with identification of outcomes
Correct Answer: B
Rationale: Documentation is the key to protect nurses when a lawsuit is filed. The thorough documentation should include all steps of the nursing process - assessment, analysis, plan, intervention, evaluation.