Nokea
The client asks the clinic nurse if he should take 2,000 mg of vitamin C a day to prevent getting a cold. On which scientific rationale should the nurse base the response?
- A. Vitamin C in this dosage will help cure the common cold.
- B. This vitamin must be taken with echinacea to be effective.
- C. This dose of vitamin C is not high enough to help prevent colds.
- D. Megadoses of vitamin C may cause crystals to form in the urine.
Correct Answer: D
Rationale: Megadoses of vitamin C (>2,000 mg/day) can lead to oxalate crystal formation in urine, increasing kidney stone risk. Evidence for cold prevention is weak, and echinacea or higher doses are not supported.
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The employee health nurse is observing a student nurse administer a PPD tuberculin test to a new employee. Which behavior would warrant immediate intervention by the employee health nurse?
- A. The student nurse inserts the needle at a 45-degree angle.
- B. The student nurse cleanses the forearm with alcohol.
- C. The student nurse circles the injection site with ink.
- D. The student nurse instructs the employee to return in three (3) days.
Correct Answer: A
Rationale: PPD tests require a 10–15-degree angle for intradermal injection to form a wheal; 45 degrees is incorrect and warrants intervention. Other actions are standard.
A client with amyotrophic lateral sclerosis has a percutaneous endoscopic gastrostomy (PEG) tube for the administration of feedings and medications. Which nursing action is appropriate?
- A. Pulverize all medications to a powdery condition
- B. Squeeze the tube before using it to break up stagnant liquids
- C. Cleanse the skin around the tube daily with hydrogen peroxide
- D. Flush adequately with water before and after using the tube
Correct Answer: D
Rationale: Flush adequately with water before and after using the tube. Flushing the tube before and after use not only provides for good tube maintenance, it is flushing that moves medications through. Not all medications should be crushed, for example sustained release preparations should not be cut or pulverized. Stagnant liquids are reduced by flushing after tube use. Cleansing is important, but soap and water are sufficient without the added irritation of hydrogen peroxide.
For which client should the nurse question administering the muscarinic cholinergic agonist oxybutynin (Ditropan)?
- A. The client diagnosed with overactive bladder.
- B. The client diagnosed with type 2 diabetes.
- C. The client diagnosed with glaucoma.
- D. The client diagnosed with peripheral vascular disease.
Correct Answer: C
Rationale: Oxybutynin’s anticholinergic effects can increase intraocular pressure, contraindicating it in glaucoma. It’s appropriate for overactive bladder; diabetes or PVD are not contraindications.
The client with coronary artery disease is prescribed atorvastatin (Lipitor) to help decrease the client's cholesterol level. Which intervention should the nurse discuss with the client concerning this medication?
- A. The client should eat a low-cholesterol, low-fat diet.
- B. The client should take this medication with each meal.
- C. The client should take this medication in the evening.
- D. The client should monitor daily cholesterol levels.
Correct Answer: C
Rationale: Atorvastatin is most effective at night when cholesterol synthesis peaks, per pharmacodynamics. Diet is supportive, meals are irrelevant, and daily monitoring is impractical.
The nurse is preparing to administer the morning dose of digoxin, a cardiac glycoside, to a client diagnosed with congestive heart failure. Which data would indicate the medication is effective?
- A. The apical heart rate is 72 beats per minute.
- B. The client denies having any anorexia or nausea.
- C. The client's blood pressure is 120/80 mm Hg.
- D. The client's lungs sounds are clear bilaterally.
Correct Answer: D
Rationale: Clear lung sounds indicate reduced fluid overload in CHF, a sign of digoxin’s effectiveness in improving cardiac output. HR, nausea, or BP are less specific.