Nokea
The client is prescribed ipratropium (Atrovent) and albuterol (Proventil) via inhaler. Which instruction should the nurse include?
- A. Use albuterol first, then ipratropium.'
- B. Use ipratropium first, then albuterol.'
- C. Use both inhalers simultaneously.'
- D. Use only one inhaler per day.'
Correct Answer: A
Rationale: Albuterol, a bronchodilator, is used first to open airways, followed by ipratropium, an anticholinergic, to maintain bronchodilation. Simultaneous or single daily use is incorrect.
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The nurse is assessing elderly clients at a community center.
- A. Dry mouth
- B. Loss of one inch of height in the last year
- C. Stiffened joints
- D. Rales bilaterally on chest auscultation
Correct Answer: D
Rationale: Rales bilaterally indicate possible pulmonary edema or infection, which are serious conditions requiring immediate attention. Dry mouth (A), height loss (B), and stiffened joints (C) are common in aging but less urgent.
Which of the following would differentiate acute from chronic respiratory acidosis in the assessment of the trauma client?
- A. Increased PaCO2
- B. Decreased PaO2
- C. Increased HCO3
- D. Decreased base excess
Correct Answer: C
Rationale: Increased PaCO2 is present in both acute and chronic respiratory acidosis due to hypoventilation. Decreased PaO2 may occur in respiratory acidosis but does not differentiate acute from chronic. Increased HCO3 indicates renal compensation, which occurs in chronic respiratory acidosis as the body attempts to buffer the excess CO2, but not in acute cases where compensation has not yet occurred. Decreased base excess is not specific to differentiating acute from chronic respiratory acidosis.
The client is receiving total parenteral nutrition (TPN). Which assessment finding requires immediate action?
- A. Blood glucose of 200 mg/dL
- B. Weight gain of 1 pound in 24 hours
- C. Temperature of 99.8°F
- D. Dry, cracked lips
Correct Answer: A
Rationale: A blood glucose of 200 mg/dL indicates hyperglycemia, a common TPN complication requiring immediate action to adjust infusion or administer insulin. Weight gain, low-grade fever, and dry lips are less urgent.
Which of the following activities have been associated with an increase in lead exposure?
- A. Working with stained glass
- B. Drinking from disposable water bottles
- C. Restoring collectible toys
- D. Drinking coffee and tea from decorative ceramic mugs
- E. Using non-stick cookware
- F. Residing in a home constructed before 1950
Correct Answer: A, C, D, F
Rationale: Lead exposure risks include stained glass work (A), restoring old toys (C), decorative mugs (D), and pre-1950 homes (F) due to lead-based paint or glazes. Disposable bottles (B) and non-stick cookware (E) are not significant sources.
The client with a history of epilepsy is prescribed valproic acid (Depakote). Which laboratory test should the nurse monitor?
- A. Liver function tests
- B. Renal function tests
- C. Complete blood count
- D. Electrolytes
Correct Answer: A
Rationale: Valproic acid can cause hepatotoxicity, so liver function tests (e.g., AST, ALT) are monitored regularly. Renal function, blood counts, and electrolytes are less commonly affected.