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The healthcare provider prescribes naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, 'The pills don't seem to be working. They are not helping the pain at all.' Which factor should influence the nurse's response?
- A. Noncompliance is probably affecting optimal medication effectiveness.
- B. Drug dosage is inadequate and needs to be increased to three times a day.
- C. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream.
- D. NSAID response is variable, and trying another NSAID may be more effective.
Correct Answer: D
Rationale: Step 1: NSAID response is variable - Different individuals respond differently to NSAIDs like naproxen due to genetic and physiological differences.
Step 2: Trying another NSAID may be more effective - If the current NSAID is not effective, switching to a different one with a different mechanism of action may provide better pain relief.
Step 3: Individualized approach - Tailoring the treatment to the individual's response is key in managing osteoarthritis pain effectively.
Summary: Choice D is correct as it acknowledges the variability in NSAID response and suggests trying another NSAID if the current one is ineffective. Choices A, B, and C are incorrect as they do not address the variable response to NSAIDs and do not provide a solution to address the lack of pain relief.
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In evaluating a 10-year-old child with meningitis suspected of having diabetes insipidus, which finding is indicative of diabetes insipidus?
- A. Decreased urine specific gravity.
- B. Elevated urine glucose.
- C. Decreased serum potassium.
- D. Increased serum sodium.
Correct Answer: A
Rationale: The correct answer is A: Decreased urine specific gravity. In diabetes insipidus, there is an inability to concentrate urine, leading to decreased urine specific gravity. This is due to the decreased production or action of antidiuretic hormone (ADH). As a result, the kidneys are unable to reabsorb water efficiently, causing dilute urine with low specific gravity.
Incorrect choices:
B: Elevated urine glucose is more indicative of diabetes mellitus, not diabetes insipidus.
C: Decreased serum potassium is not a typical finding in diabetes insipidus.
D: Increased serum sodium can occur due to dehydration from excessive urination in diabetes insipidus, but it is not directly indicative of the condition.
The client has acute pancreatitis. Which nursing intervention is the highest priority?
- A. Administer pain medication as prescribed.
- B. Monitor the client's serum amylase and lipase levels.
- C. Encourage oral intake of clear liquids.
- D. Assess the client's bowel sounds every 4 hours.
Correct Answer: A
Rationale: The correct answer is A: Administer pain medication as prescribed. This is the highest priority because acute pancreatitis is a painful condition, and managing pain is crucial for the client's comfort and well-being. Pain control also helps reduce stress on the pancreas and can aid in preventing complications.
Choice B is incorrect because while monitoring serum amylase and lipase levels is important in diagnosing pancreatitis and assessing response to treatment, it is not the highest priority intervention.
Choice C is incorrect as encouraging oral intake of clear liquids may exacerbate pancreatitis symptoms and lead to further complications.
Choice D is incorrect as assessing bowel sounds, while important for monitoring gastrointestinal function, is not the highest priority in the acute management of pancreatitis.
When evaluating a client's understanding of wearing a Holter monitor, which statement made by the client would indicate to the nurse that the client understands the procedure?
- A. I must record any symptoms occurring with my activity.
- B. I am not looking forward to staying in bed for 24 hours.
- C. I really am dreading the frequent blood drawing.
- D. I know that I shouldn't get close to my microwave oven.
Correct Answer: A
Rationale: The correct answer is A because it demonstrates the client understands the purpose of wearing a Holter monitor—to record symptoms related to activity. This shows the client comprehends the importance of monitoring symptoms accurately. Choices B, C, and D are incorrect because they do not relate to the purpose of wearing a Holter monitor or indicate an understanding of the procedure. B focuses on personal preference, C on unrelated procedures, and D on irrelevant safety precautions.
A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?
- A. Glasgow Coma Scale
- B. Assess pulses, paresthesia, and paralysis distal to the right knee
- C. Assess pulses, paresthesia, and paralysis proximal to the right knee
- D. Optic nerve using an ophthalmoscope
Correct Answer: B
Rationale: The correct answer is B: Assess pulses, paresthesia, and paralysis distal to the right knee. This is the appropriate action because the client presents with warm, edematous right knee and calf, indicating a potential vascular issue like deep vein thrombosis (DVT). Assessing pulses, paresthesia, and paralysis distal to the right knee helps evaluate circulation and nerve function, crucial in identifying complications of DVT. Glasgow Coma Scale (A) is used to assess consciousness, not relevant in this case. Assessing proximal pulses, paresthesia, and paralysis (C) may not provide accurate information about circulation distal to the knee. Evaluating the optic nerve (D) using an ophthalmoscope is unrelated to the client's presenting symptoms and medical history.
Because the census is currently low in the Obstetrics (OB) unit, one of the nurses is sent to work on a medical-surgical unit for the day, or until the OB unit becomes busy. Which client assessment is best for the charge nurse to assign to the OB nurse?
- A. An adult who had a colon resection yesterday and has an IV.
- B. An older adult who has a fever of unknown origin.
- C. A woman who had an acute brain attack (stroke, CVA) 6 hours ago.
- D. A teenager with a femoral fracture who is in traction.
Correct Answer: A
Rationale: The correct answer is A because the OB nurse's background in obstetrics makes them most suitable to care for a post-operative patient with an IV. This assignment aligns with the nurse's skill set and ensures safe and competent care. Choices B, C, and D involve medical-surgical conditions that may require specialized knowledge and skills beyond the OB nurse's expertise, potentially compromising patient care. Assigning the OB nurse to care for a post-operative patient with an IV is the most appropriate choice given the circumstances.