Nokea
Atropine sulfate (Atropine) is contraindicated in all but which one of the following clients?
- A. A client with diabetes.
- B. A client with glaucoma.
- C. A client with urine retention.
- D. A client with bowel obstruction.
Correct Answer: A
Rationale: Atropine is contraindicated in glaucoma (increases intraocular pressure), urine retention (worsens retention), and bowel obstruction (reduces motility). It is not contraindicated in diabetes, as it has no direct effect on glucose metabolism.
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After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days to stabilize the body's need for steroids postoperatively. Which of the following exercises will be most effective for preparing a client for ambulation after a period of bed rest?
- A. Alternately flexing and extending the knees.
- B. Alternately abducting and adducting the legs.
- C. Alternately stretching the Achilles tendons.
- D. Alternately flexing and relaxing the quadriceps femoris muscles.
Correct Answer: A
Rationale: Knee flexion and extension strengthen leg muscles, preparing the client for ambulation after bed rest.
A nurse is preparing to administer furosemide intravenously to a client. Which action should the nurse perform before administering this medication?
- A. Insert an indwelling urinary catheter.
- B. Review the client's most recent pulse
- C. Establish continuous pulse oximeter monitoring
- D. Assess the client's serum electrolytes
Correct Answer: D
Rationale: Furosemide can cause electrolyte imbalances, so assessing serum electrolytes is critical before administration.
A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? Select all that apply.
- A. Rapid pulse.
- B. Decreased energy and fatigue.
- C. Weight gain of 10 lb.
- D. Fine, thin hair with hair loss.
- E. Constipation.
- F. Monorrhagia.
Correct Answer: B,C,D,E,F
Rationale: Hypothyroidism slows metabolism, leading to decreased energy, fatigue, weight gain, hair loss, constipation, and heavy menstrual periods (menorrhagia). Rapid pulse is associated with hyperthyroidism, not hypothyroidism.
The son of a 78-year-old client with metastatic prostate cancer is asking the nurse about the purpose of hospice care. Which of the following statements by the nurse best describes hospice care?
- A. Hospice care uses a team approach to direct hospice activity.
- B. Clients and their families are the focus of care.
- C. The client's physician coordinates all the care.
- D. All hospice clients will die at home.
Correct Answer: B
Rationale: Hospice care focuses on the client and family, providing holistic support to enhance quality of life and comfort during the end-of-life phase.
A client has been admitted with acute renal failure. What should the nurse do? Select all that apply.
- A. Elevate the head of the bed 30 to 45 degrees.
- B. Take vital signs.
- C. Establish an I.V. access site.
- D. Call the admitting physician for orders.
- E. Contact the hemodialysis unit.
Correct Answer: B,C,D
Rationale: Taking vital signs, establishing IV access, and contacting the physician are immediate actions to assess and stabilize the client with acute renal failure.