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The client diagnosed with substance abuse is being discharged from a drug and alcohol rehabilitation facility. Which information should the nurse teach the client?
- A. Do not go anyplace where you can be tempted to use again.'
- B. It is important that you attend a 12-step meeting regularly.'
- C. Now that you are clean, your family will be willing to see you again.'
- D. You should explain to all your coworkers what has happened.'
Correct Answer: B
Rationale: 12-step programs (B) provide ongoing support and accountability, critical for maintaining sobriety. Avoiding temptation (A) is vague, family reconciliation (C) is not guaranteed, and disclosing to coworkers (D) may breach privacy.
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The nurse is preparing to administer acetaminophen (Tylenol) to a client diagnosed with a stroke who is complaining of a headache. Which intervention should the nurse implement first?
- A. Administer the medication in pudding.
- B. Check the client's armband.
- C. Crush the tablet and dissolve in juice.
- D. Have the client sip some water.
Correct Answer: B
Rationale: Checking the armband (B) ensures patient safety before medication administration. Pudding (A), crushing (C), or sipping water (D) follow identity confirmation.
The nurse identifies the concept of intracranial regulation disturbance in a client diagnosed with Parkinson’s Disease. Which priority intervention should the nurse implement?
- A. Keep the bed low and call light in reach.
- B. Provide a regular diet of three (3) meals per day.
- C. Obtain an order for home health to see the client.
- D. Perform the Braden scale skin assessment.
Correct Answer: A
Rationale: Parkinson’s increases fall risk due to bradykinesia and rigidity. Keeping the bed low and call light in reach (A) prioritizes safety. Diet (B), home health (C), and skin assessment (D) are secondary.
Which medication should the nurse administer first during a prolonged seizure?
- A. Phenytoin (Dilantin) IV
- B. Lorazepam (Ativan) IV
- C. Levetiracetam (Keppra) oral
- D. Carbamazepine (Tegretol) oral
Correct Answer: B
Rationale: Lorazepam IV is the first-line treatment for status epilepticus to rapidly stop seizure activity.
Which nursing action would be most appropriate if the client develops anorexia and nausea while taking interferon beta-1a (Avonex)?
- A. Withhold the medication.
- B. Offer frequent mouth care.
- C. Administer the drug after meals.
- D. Provide small, easy to digest meals.
Correct Answer: D
Rationale: Providing small, easy-to-digest meals helps manage nausea and encourages nutritional intake without altering the medication schedule.
Which assessment data should the nurse expect to observe for the client diagnosed with Parkinson's disease?
- A. Ascending paralysis and pain.
- B. Masklike facies and pill rolling.
- C. Diplopia and ptosis.
- D. Dysphagia and dysarthria.
Correct Answer: B
Rationale: Masklike facies and pill-rolling tremors (B) are hallmark Parkinson’s signs due to dopamine deficiency. Paralysis/pain (A) suggest Guillain-Barré, diplopia/ptosis (C) indicate myasthenia gravis, and dysphagia/dysarthria (D) are later symptoms.