Nokea
For each potential provider prescription click to specify if the prescription is anticipated or contraindicated for the client.
- A. Administer famotidine 20 mg via intermittent IV infusion twice daily.
- B. insert an indwelling urinary catheter.
- C. Administer lactated Ringer's 1L via IV bolus.
- D. Insert a nasogastric tube and maintain low intermittent suction.
Correct Answer: A,C,D
Rationale: [Explanation: The correct answer is - A,C,D. Administering famotidine helps reduce stomach acid, beneficial for clients with gastric issues. Lactated Ringer's IV bolus helps with fluid resuscitation. Inserting a nasogastric tube can help with decompression or feeding. Inserting an indwelling urinary catheter is not typically provider-initiated unless medically necessary. Therefore, A, C, and D are anticipated for client care, while B is contraindicated unless specifically indicated.]
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Which of the following tasks should the charge nurse assign to a licensed practical nurse?
- A. Complete discharge teaching for a client who has a new diagnosis of diabetes mellitus.
- B. Complete the Glasgow Coma Scale for a client who has an evolving stroke.
- C. Perform a sterile dressing change for a client who has an abdominal wound.
- D. Perform an admission assessment for a client who is scheduled for surgery.
Correct Answer: C
Rationale: LPNs are trained for sterile dressing changes.
Which of the following statements by the client indicate an understanding of the discharge teaching? Select all that apply.
- A. I will eat small, frequent meals.
- B. I should expect my bowel movements to be pale in color.
- C. I will limit my morning coffee to no more than two cups.
- D. I will notify my provider if my urine is dark.
- E. I will eat fish for dinner at least twice per week.
Correct Answer: A,D,E
Rationale: The correct statements (A, D, E) demonstrate an understanding of discharge teaching. A shows awareness of dietary recommendations post-discharge. D indicates knowledge of abnormal urine color as a reason to notify the provider. E reflects comprehension of incorporating fish in the diet for health benefits. The incorrect choices (B, C) suggest misconceptions. B is inaccurate as pale bowel movements may indicate a liver issue. C may be harmful as coffee can interfere with medication.
Which of the following actions should the nurse plan to take?
- A. The nurse should use a filter needle to withdraw the medication.
- B. The nurse should break the neck of the ampule toward their body
- C. The nurse should use the same needle to draw up and inject the client
- D. The nurse should dispose of the ampule in the trash can.
Correct Answer: A
Rationale: The correct answer is A: The nurse should use a filter needle to withdraw the medication. This is the correct action as filter needles help prevent the introduction of particulate matter or impurities into the medication, ensuring patient safety. Using a filter needle also reduces the risk of needlestick injuries and contamination.
Choice B is incorrect as breaking the neck of the ampule towards the body increases the risk of injury due to glass shards flying towards the nurse. Choice C is incorrect as it violates safe medication administration practices by risking contamination. Choice D is incorrect as ampules should be disposed of in a sharps container, not the trash can.
The nurse should identity which of the following conditions as a contraindication for receiving this treatment?
- A. Hypertension
- B. Obesity
- C. Hypothyroidism
- D. Herpes zoster
Correct Answer: D
Rationale: The correct answer is D. Herpes zoster is a contraindication for certain treatments because it is a viral infection that can worsen with immunosuppressive therapy. Hypertension, obesity, and hypothyroidism are not direct contraindications for receiving the treatment mentioned. Hypertension can be managed, obesity and hypothyroidism do not directly impact the treatment's efficacy. Herpes zoster, on the other hand, can lead to serious complications if the treatment suppresses the immune system. It is crucial to address active infections before starting immunosuppressive therapy to prevent further complications.
Which of the following responses should the nurse make?
- A. Are you not happy with your treatment?
- B. We can provide a copy of your records, but the therapist's notes are not included.
- C. Why are you interested in seeing your therapist's notes?
- D. I don't think you will benefit from reviewing your therapist's notes right now.
Correct Answer: B
Rationale: The correct response is B: "We can provide a copy of your records, but the therapist's notes are not included." This answer respects the patient's request for records while also maintaining confidentiality of the therapist's notes. Offering a copy of the records shows transparency and willingness to provide information to the patient. Choices A, C, and D are incorrect because they do not address the patient's request appropriately - A assumes dissatisfaction, C questions the patient's motive, and D dismisses the request without explanation.