Nokea
An adult client who has been taking furosemide (Lasix) 40 mg PO every day for several weeks is complaining of muscle weakness and lethargy. Which test will be of greatest value in assessing the client's condition?
- A. Serum electrolytes
- B. Urinalysis
- C. Serum creatinine
- D. Five-hour glucose tolerance test
Correct Answer: A
Rationale: Furosemide can cause hypokalemia, leading to muscle weakness and lethargy; serum electrolytes assess potassium levels.
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The nurse is evaluating the client's home medications and notes the client with angina is taking an antidepressant. Which intervention should the nurse implement because the client is taking this medication?
- A. Ask the client if there is a plan for suicide.
- B. Assess the client's depression on a 1-to-10 scale.
- C. Explain this medication cannot be taken because of the angina.
- D. Request a referral to the hospital psychologist.
Correct Answer: A
Rationale: Antidepressants in angina patients raise suicide risk concerns; assessing for a plan is the priority to ensure safety.
A pregnant woman is hospitalized for treatment of pregnancy induced hypertension (PIH) in the third trimester. She is receiving magnesium sulfate intravenously. The nurse understands that this medication is used mainly for what purpose?
- A. Maintain normal blood pressure
- B. Prevent convulsive seizures
- C. Increase the respiratory rate
- D. Increase uterine blood flow
Correct Answer: B
Rationale: Prevent convulsive seizures. Magnesium sulfate is a central nervous system depressant. While it has many systemic effects, it is used in the client with pregnancy induced hypertension (PIH) to prevent seizures.
A 10-month-old child has been diagnosed as having acute otitis media. The pediatrician prescribed amoxicillin suspension. What instructions should the nurse give the child's mother?
- A. When your child's temperature has been normal for two days, discontinue the medicine.
- B. Discard any unused medication.
- C. If your child has symptoms of an ear infection again, start giving her the leftover medication.
- D. Give your child all of the medication in the bottle.
Correct Answer: B
Rationale: The nurse should instruct to discard unused medication to prevent misuse. The full course should be completed, but the bottle is only good for two weeks.
The client with epilepsy is prescribed carbamazepine (Tegretol), an anticonvulsant. Which discharge instruction should the nurse include in the teaching?
- A. Wear SPF 15 sunscreen when outside.
- B. Obtain regular serum drug levels.
- C. Be sure to floss teeth daily.
- D. Instruct the client to take tub baths only.
Correct Answer: B
Rationale: Carbamazepine requires serum level monitoring to ensure therapeutic range and avoid toxicity. Sunscreen, flossing, or baths are less relevant.
The client in end-stage renal disease is receiving aluminium hydroxide (Amphojel). Which assessment data indicate the medication is effective?
- A. The client denies complaints of indigestion.
- B. The client is not experiencing burning on urination.
- C. The client has had a normal, soft bowel movement.
- D. The client's phosphate level has decreased.
Correct Answer: D
Rationale: Amphojel binds phosphate in ESRD, lowering serum levels; decreased phosphate indicates effectiveness. Indigestion, urination, or bowel movements are unrelated.