Nokea
Before administering the initial dose of sumatriptan succinate to a client with a migraine headache, it is most important to determine if the client's history includes which problem?
- A. Coronary artery disease.
- B. Irritable bowel syndrome.
- C. Seasonal allergic rhinitis.
- D. Type 2 diabetes mellitus.
Correct Answer: A
Rationale: Sumatriptan causes vasoconstriction, which can exacerbate coronary artery disease, making this history critical to assess. IBS, rhinitis, and diabetes are not contraindications.
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History and physical
The client is a 26-year-old female with acute appendicitis. She has a 12 year history of type 1 diabetes mellitus and no other significant medical history. The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.
Nurses notes
0730
Admitted the client. She is awake and alert. She rates her pain 2 on a 0 to 10 pain scale. Her pulses are equal bilaterally. Heart rate is 76 beats/minute, normal sinus rhythm. Her oxygen saturation is 100% on room air. She has a gauze dressing over her surgical site, which is clean and dry. Her temperature is 98.5° F (37.0° C) orally. She urinated 50 mL upon arrival in the unit and is reporting she
Lab results
Blood glucose 279mg/dl
Orders
Admit to the surgical floor
• Dextrose 5% and 0.9% sodium chloride IV to infuse at 125 mL/hr
Advance diet as tolerated
• Insulin glargine 12 units SUBQ every 24 hours
. Ceftriaxone 2 gram IV piggy back (IVPB) every
24 hours for 3 days, first dose given in surgery
It is 1800, and the client has a scheduled dose of insulin glargine due. The client has a regular diet tray ordered with 60 carbohydrates. The tray has not yet arrived in the room. For each nursing action below, click to specify if the action is indicated, contraindicated or nonessential.Each row must have one option selected.
- A. Give insulin lispro 4 units: Contraindicated
- B. Verify that the client can count carbohydrates: Nonessential
- C. Mix the insulin lispro and insulin glargine in one syringe: Contraindicated
- D. Give insulin glargine 12 units: Indicated
Correct Answer:
Rationale: A: Lispro is contraindicated without meal intake to avoid hypoglycemia. B: Carb counting is nonessential for scheduled glargine. C: Mixing lispro and glargine is contraindicated. D: Glargine is indicated as scheduled.
A client is receiving tamsulosin, an alpha-adrenergic blocking agent, for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide?
- A. Reduce daily fluid intake.
- B. Stand and sit up slowly.
- C. Take the medication early in the day.
- D. Use a twice-a-week dosing schedule.
Correct Answer: B
Rationale: Tamsulosin may cause orthostatic hypotension, so standing and sitting slowly prevents dizziness or falls. Fluid reduction, early dosing, or twice-weekly schedules are incorrect for tamsulosin.
A client with a cold is taking the antitussive medication benzonatate. Which assessment information indicates to the nurse that the medication is effective?
- A. Denies having coughing spells.
- B. Able to sleep through the night.
- C. Expectorating bronchial secretions.
- D. Reports reduced nasal discharge.
Correct Answer: B
Rationale: Benzonatate suppresses cough, and sleeping through the night indicates effective cough control. Denying coughing spells is less specific, expectoration relates to expectorants, and nasal discharge is unrelated to antitussive effects.
A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in the client's plan of care?
- A. Limit the intake of foods high in potassium.
- B. Cover your skin before going outside.
- C. Monitor skin for excessive bruising.
- D. Replace salt with a salt substitute.
Correct Answer: A
Rationale: Spironolactone is potassium-sparing, so limiting potassium-rich foods prevents hyperkalemia. Sun protection, bruising, and salt substitutes (often potassium-based) are not primary concerns.
A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?
- A. pH.
- B. Phosphate.
- C. Potassium.
- D. Calcium.
Correct Answer: B
Rationale: Calcium acetate lowers phosphate levels in CKD by binding dietary phosphate. A decreased phosphate level indicates effectiveness. pH, potassium, and calcium are not primary targets.