Nokea
How many mLs will you administer to the client after you use 3.3 mL of normal saline to reconstitute a medication that will yield 12 mg per mL and the doctor's order is as follows. Doctor's order: 25 mg of medication BID
- A. 1.9 mL
- B. 2.0 mL
- C. 2.5 mL
- D. 2.1 mL
Correct Answer: D
Rationale: To calculate: 25 mg ÷ 12 mg/mL = 2.083 mL, rounded to 2.1 mL for practical administration.
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A client with a history of hypothyroidism is prescribed levothyroxine (Synthroid). The nurse should monitor the client for which of the following signs of overdose?
- A. Tachycardia.
- B. Weight gain.
- C. Cold intolerance.
- D. Bradycardia.
Correct Answer: A
Rationale: Tachycardia indicates levothyroxine overdose due to excessive thyroid hormone.
A client admitted in an acute psychotic state says that she hears terrible voices in the head and thinks her neighbor is out to get her. Which of the following is the nurse's best response?
- A. What has your neighbor been doing that bothers you?'
- B. How long have you been hearing these terrible voices?'
- C. I won't let your neighbor visit, so you'll be safe.'
- D. What exactly are these terrible voices saying to you?'
Correct Answer: D
Rationale: Asking about the content of the voices helps assess the nature of the hallucinations and potential risks, guiding therapeutic intervention.
A client has a prescription to begin short-term therapy with enoxaparin. The nurse explains to the client that this medication is being prescribed for which action?
- A. Dissolve urinary calculi
- B. Relieve migraine headaches
- C. Stop progression of multiple sclerosis
- D. Reduce the risk of deep vein thrombosis
Correct Answer: D
Rationale: Enoxaparin is an anticoagulant that is administered to prevent deep vein thrombosis and thromboembolism in selected clients at risk. It is not used to treat urinary calculi, migraine headaches, or multiple sclerosis.
When giving a client a tube feeding the nurse should:
- A. Warm the feeding solution before administration.
- B. Place the client in a left side-lying position.
- C. Aspirate residual gastric contents before the feeding and discard.
- D. Verify position of the tube before beginning feeding.
Correct Answer: D
Rationale: Verifying tube position (e.g., via pH testing or X-ray) is critical to ensure safe administration and prevent aspiration.
The nurse teaches the mother of a toddler who has had cleft palate repair that her child is at risk for developing which of the following in the future?
- A. Hearing problems.
- B. Speech defect.
- C. Chronic sinus infections.
- D. Tonsillitis.
Correct Answer: A, B
Rationale: Cleft palate repair increases the risk of hearing problems (due to Eustachian tube dysfunction) and speech defects.