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The client is prescribed a loading dose of phenytoin of 15 mg/kg IV for seizure activity, then 100 mg IV tid. The client weighs 198 lb. What dose in mg should the nurse administer for the loading dose of phenytoin?
- A. 1350 mg IV
Correct Answer: 1350
Rationale: 198 lb = 90 kg; (198 ÷ 2.2 = 90 kg; 90 x 15 = 1350) The nurse should administer 1350 mg phenytoin (Dilantin).
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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.
The client is diagnosed with a metastatic brain tumor, and radiation therapy is scheduled. The client asks the nurse, 'Why not try chemotherapy first? It has helped my other tumors.' The nurse’s response is based on which scientific rationale?
- A. Chemotherapy is only used as a last resort in caring for clients with brain tumors.
- B. The blood-brain barrier prevents medications from reaching the brain.
- C. Radiation therapy will have fewer side effects than chemotherapy.
- D. Metastatic tumors become resistant to chemotherapy and it becomes useless.
Correct Answer: B
Rationale: The blood-brain barrier (B) limits chemotherapy penetration into the brain, making radiation more effective for brain metastases. Chemotherapy is used in some cases (A), radiation side effects vary (C), and resistance (D) is not universally true.
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.
The public health department nurse is preparing a lecture on prevention of West Nile virus. Which information should the nurse include?
- A. Change water daily in pet dishes and birdbaths.
- B. Wear thick, dark clothing when outside to avoid bites.
- C. Apply insect repellent over face and arms only.
- D. Explain that mosquitoes are more prevalent in the morning.
Correct Answer: A
Rationale: Changing water daily in pet dishes and birdbaths (A) prevents mosquito breeding, reducing West Nile virus risk. Thick clothing (B) should be light-colored, repellent (C) should cover all exposed areas, and mosquitoes are more active at dusk (D).
Which nursing task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel?
- A. Teach Credé’s maneuver to the client needing to void.
- B. Administer the tube feeding to the client who is quadriplegic.
- C. Assist with bowel training by placing the client on the bedside commode.
- D. Observe the client demonstrating self-catheterization technique.
Correct Answer: C
Rationale: Assisting with bowel training by placing the client on a commode (C) is within the UAP’s scope, involving physical assistance. Teaching (A), administering tube feedings (B), and observing techniques (D) require nursing judgment and are not delegable.