Nokea
The client is diagnosed with glaucoma. Which medication is most likely to be prescribed?
- A. Timolol (Timoptic)
- B. Atropine (Isopto Atropine)
- C. Pilocarpine (Isopto Carpine)
- D. Acetazolamide (Diamox)
Correct Answer: A
Rationale: Timolol, a beta-blocker, is commonly prescribed for glaucoma to reduce intraocular pressure by decreasing aqueous humor production. Atropine increases pressure, pilocarpine is less common, and acetazolamide is used acutely.
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The FHR pattern in a laboring client begins to show early decelerations. The nurse would best respond by:
- A. Notifying the physician
- B. Changing the client to the left lateral position
- C. Continuing to monitor the FHR closely
- D. Administering O2 at 8 L/min via face mask
Correct Answer: C
Rationale: Early decelerations are reassuring and do not warrant notification of the physician. Because early decelerations is a reassuring pattern, it would not be necessary to change the client's position. Early decelerations warrant the continuation of close FHR monitoring to distinguish them from more ominous signs. O2 is not warranted in this situation, but it is warranted in situations involving variable and/or late decelerations.
The nurse is caring for a client after a motor vehicle accident. The client has a fractured tibia, and bone is noted protruding through the skin. Which action is of priority?
- A. Provide manual traction above and below the leg.
- B. Cover the bone area with a sterile dressing.
- C. Apply an ACE bandage around the entire lower limb.
- D. Place the client in the prone position.
Correct Answer: B
Rationale: Covering an open fracture with a sterile dressing prevents infection, a priority. Traction (A) is secondary, an ACE bandage (C) may contaminate the wound, and prone positioning (D) is inappropriate.
The nurse is caring for a client with a history of anaphylaxis to peanuts. Which precaution is most important?
- A. Keep an epinephrine auto-injector at the bedside.
- B. Place the client in a private room.
- C. Administer antihistamines daily.
- D. Monitor for respiratory distress every 4 hours.
Correct Answer: A
Rationale: An epinephrine auto-injector is critical for immediate treatment of anaphylaxis, a life-threatening allergic reaction. Private rooms, antihistamines, and monitoring are secondary to ensuring rapid emergency response.
Forty-eight hours after a thyroidectomy, a female client complains of numbness and tingling of the toes and fingers. The nurse notes upper arm and facial twitching. The nurse needs to:
- A. Report the findings to the physician
- B. Assist the client to do range of motion exercises
- C. Check the client's potassium level
- D. Administer the as-needed dose of phenytoin (Dilantin)
Correct Answer: A
Rationale: Muscular hyperactivity and parasthesias may indicate hypocalcemic tetany and require immediate administration of calcium gluconate. Tetany can occur if the parathyroid glands were erroneously excised during surgery. Range of motion exercises are not appropriate to presenting symptoms. These characteristics are not usual signs of potassium imbalance, but of calcium imbalance. Phenytoin is indicated for seizure activity mainly of neurological origin.
In assessing cardiovascular clients with progression of aortic stenosis, the nurse should be aware that there is typically:
- A. Decreased pulmonary blood flow and cyanosis
- B. Increased pressure in the pulmonary veins and pulmonary edema
- C. Systemic venous engorgement
- D. Increased left ventricular systolic pressures and hypertrophy
Correct Answer: D
Rationale: These signs are seen in pulmonic stenosis or in response to pulmonary congestion and edema and mitral stenosis. These signs are seen primarily in mitral stenosis or as a late sign in aortic stenosis after left ventricular failure. These signs are seen primarily in right-sided heart valve dysfunction. Left ventricular hypertrophy occurs to increase muscle mass and overcome the stenosis; left ventricular pressures increase as left ventricular volume increases owing to insufficient emptying.