Nokea
The nurse in an ambulatory care center is reinforcing teaching to a client with a diagnosis of persistent depressive disorder (dysthymia) about the appropriate use of bupropion hydrochloride sustained release. What statement by the client indicates a need for further teaching?
- A. If I have a sudden change in my mood, I should call my physician immediately.
- B. If I have trouble swallowing the tablet, I can cut it in half.
- C. If I miss a dose, I should not double the next dose to catch up.
- D. It may take several weeks before I get better.
Correct Answer: B
Rationale: Bupropion sustained-release tablets must not be cut, as this disrupts the controlled-release mechanism, risking side effects. Other statements are correct: mood changes require reporting, missed doses shouldn't be doubled, and therapeutic effects take weeks.
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The nurse is caring for a man who had a transsphenoidal hypophysectomy earlier today. He says he has to spit a lot. What nursing action is essential?
- A. Ask him to blow his nose.
- B. Do a glucose test on his mouth secretions.
- C. Have him rinse his mouth with water.
- D. Ask him if he needs an antiemetic.
Correct Answer: B
Rationale: Excessive spitting may indicate cerebrospinal fluid (CSF) leak, which contains glucose; testing secretions confirms this serious complication.
The nurse is caring for an adult being admitted with a head injury. The nurse plans to place the client in which position?
- A. Prone
- B. Supine
- C. Semi-reclining
- D. Upright
Correct Answer: C
Rationale: Semi-reclining (30-45 degrees) reduces intracranial pressure in head injury by promoting venous drainage, unlike prone, supine, or upright positions.
The nurse admits a 7 year-old to the emergency room after a leg injury. The x-rays show a femur fracture near the epiphysis. The parents ask what will be the outcome of this injury. The appropriate response by the nurse should be which of these statements?
- A. The injury is expected to heal quickly because of thin periosteum.'
- B. In some instances the result is a retarded bone growth.'
- C. Bone growth is stimulated in the affected leg.'
- D. This type of injury shows more rapid union than that of younger children.'
Correct Answer: B
Rationale: An epiphyseal (growth) plate fracture in a 7 year-old often results in retarded bone growth. The leg often will be different in length than the uninjured leg.
The nurse is planning to give a 3 year-old child oral digoxin. Which of the following is the best approach by the nurse?
- A. Do you want to take this pretty red medicine?
- B. You will feel better if you take your medicine.
- C. This is your medicine, and you must take it all right now.
- D. Would you like to take your medicine from a spoon or a cup?
Correct Answer: D
Rationale: Would you like to take your medicine from a spoon or a cup? Offering a choice empowers the child and reduces resistance.
The nurse is observing a nursing assistant transfer a client from bed to chair. Which observation needs correction? Select all that apply.
- A. The nursing assistant lowers the bed before starting the procedure.
- B. The nursing assistant sits the client on the side of the bed before assisting the client to move.
- C. The nursing assistant stands with feet close together and knees and back straight when helping the client to move.
- D. The nursing assistant asks the client to grab the arm of the nursing assistant during the transfer.
- E. The nursing assistant lifts the client up by tugging on the client's arms.
- F. The nursing assistant assists the client to stand and pivot to get into the chair.
Correct Answer: C,D,E
Rationale: The nursing assistant should stand with feet apart and knees bent to prevent injury, not grab the client's arm, and avoid tugging on the client's arms. Lowering the bed, sitting the client up, and assisting to pivot are correct.