Nokea
An RN is working with an LPN to care for a group of clients. Which client would the RN most likely assign to the LPN?
- A. a client receiving blood following back surgery
- B. a client who has just returned from having a left heart catheterization
- C. a client with an arterial line who is on a nitroprusside drip to control blood pressure
- D. a client with an abdominal wound requiring dressing changes every 4 hours and PRN
Correct Answer: D
Rationale: The client requiring dressing changes is stable and within the LPN's scope of practice, whereas the other clients require advanced monitoring or interventions suitable for an RN.
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The registered nurse is conducting an in-service for colleagues on the subject of peptic ulcers. The nurse would be correct in identifying which of the following as a causative factor?
- A. N. gonorrhea
- B. H. influenza
- C. H. pylori
- D. E. coli
Correct Answer: C
Rationale: H. pylori is a primary causative factor in peptic ulcers, contributing to mucosal damage and ulcer formation.
A client is admitted to the hospital with seizures. The client has jerking of the right arm and twitching of the face, but is alert and aware of the seizure. This behavior is characteristic of which type of seizure?
- A. Absence
- B. Complex partial
- C. Simple partial
- D. Tonic-clonic
Correct Answer: C
Rationale: Simple partial seizures involve focal symptoms (e.g., jerking of one arm, facial twitching) without loss of consciousness, unlike complex partial or tonic-clonic seizures. Absence seizures typically involve brief staring spells.
A client with severe anemia is to receive a unit of whole blood. In the event of a transfusion reaction, the first action by the nurse should be to:
- A. Notify the physician and the nursing supervisor
- B. Stop the transfusion and maintain an IV of normal saline
- C. Call the lab for verification of type and cross match
- D. Prepare an injection of Benadryl (diphenhydramine)
Correct Answer: B
Rationale: Stopping the transfusion and maintaining an IV of normal saline is the first action to prevent further reaction and stabilize the client.
The nurse is preparing to discharge a client who is taking an MAOI. The nurse should instruct the client to:
- A. Wear protective clothing and sunglasses when outside
- B. Avoid over-the-counter cold and hayfever preparations
- C. Drink at least eight glasses of water a day
- D. Increase his intake of high-quality protein
Correct Answer: B
Rationale: MAOIs interact dangerously with OTC cold and hayfever medications containing sympathomimetics, risking hypertensive crisis.
The nurse should explain to a client that tolbutamide (Orinase) is effective for diabetics who
- A. can no longer produce any insulin.
- B. produce minimal amounts of insulin.
- C. are unable to administer their injections.
- D. have a sustained decreased blood glucose.
Correct Answer: B
Rationale: oral hypoglycemic agents are administered to type II (non-insulindependent) clients who are able to produce minimal amounts of insulin