Nokea
The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which data would cause the nurse to question administering the medication?
- A. The client's BP is 110/70
- B. The client's potassium level is 3.4 mEq/L
- C. The client has a barky cough
- D. The client's apical pulse is 56
Correct Answer: D
Rationale: The correct answer is D. A beta blocker should be withheld if the apical pulse is below 60, as it can further decrease the heart rate. Choice A is not a reason to question administering the medication as the blood pressure is within a normal range for a client with essential hypertension. Choice B is not directly related to the administration of a beta blocker. Choice C suggests a potential side effect of an ACE inhibitor, not a beta blocker.
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The nurse enters a client's room and the client is demanding release from the hospital. The nurse reviews the client's record and notes that the client was admitted 2 days ago for treatment of an anxiety disorder, and the admission was voluntary. Which intervention should the nurse initiate first?
- A. Telephone the client's family and have them persuade the client to stay
- B. Have the client read and sign all the appropriate self-discharge papers
- C. Explain to the client that he cannot leave because he asked for treatment
- D. Notify the client's healthcare provider of the client's stated intent to leave the hospital
Correct Answer: D
Rationale: The correct intervention for the nurse to initiate first is to notify the client's healthcare provider of the client's intention to leave the hospital. This is important to ensure that the client's care and safety are appropriately managed. Option A is incorrect as involving the family without proper assessment or intervention could violate the client's autonomy. Option B is incorrect because it does not involve the healthcare provider in the decision-making process. Option C is incorrect as it does not address the client's rights to make decisions about their own care.
A patient with hypothyroidism should be advised to consume more of which nutrient?
- A. Calcium
- B. Iodine
- C. Vitamin C
- D. Iron
Correct Answer: B
Rationale: The correct answer is B: Iodine. Iodine is crucial for the production of thyroid hormones. A deficiency in iodine can lead to hypothyroidism. Calcium (Choice A) is important for bone health but is not directly related to thyroid function. Vitamin C (Choice C) is essential for the immune system and skin health but does not play a significant role in thyroid function. Iron (Choice D) is vital for red blood cell production and oxygen transport but is not specifically relevant to hypothyroidism.
A client has been given instructions about ferrous sulfate. Which statement made by the client would indicate the client needs further education?
- A. I will take this medication on an empty stomach.
- B. I will take the morning dose 1 hour before breakfast.
- C. I will need to avoid taking this medication with coffee.
- D. I will take antacids if needed, 2 hours after I take ferrous sulfate.
Correct Answer: A
Rationale: The correct answer is A. Ferrous sulfate should be taken on an empty stomach to improve absorption. Choice A is incorrect as taking the medication with a full glass of milk would impair iron absorption. Choices B, C, and D are all correct statements regarding the administration of ferrous sulfate. Choice B ensures proper timing before breakfast, choice C highlights avoiding coffee due to interference with iron absorption, and choice D correctly suggests taking antacids a few hours after ferrous sulfate to prevent potential interactions.
Which of the following is a specialized medical treatment and teaching facility that provides general and specialized medical and dental care and treatment?
- A. CONUS
- B. MEDCEN
- C. MEDCOM
- D. MEDDAC
Correct Answer: B
Rationale: The correct answer is B, 'MEDCEN.' A MEDCEN (Medical Center) is a specialized medical treatment and teaching facility that offers general and specialized medical and dental care. Choice A, 'CONUS,' refers to the continental United States and is not related to medical facilities. Choice C, 'MEDCOM,' stands for Medical Command, which is an administrative entity responsible for overseeing medical units, not providing direct care. Choice D, 'MEDDAC,' refers to Medical Department Activity, which is a smaller medical unit compared to a MEDCEN and may not provide the same level of specialized care.
Participating in the development of long-term and preventive health goals with the patient and their family is a part of which of the following steps for determining and fulfilling the nursing care needs of the patient?
- A. Evaluation
- B. Planning
- C. Implementation
- D. Assessment
Correct Answer: B
Rationale: The correct answer is B: Planning. In the nursing process, planning involves developing long-term and preventive health goals in collaboration with the patient and their family. This step focuses on outlining the strategies and interventions needed to achieve the desired outcomes. Choice A, Evaluation, occurs after interventions are implemented to assess the effectiveness of the care provided. Choice C, Implementation, involves carrying out the planned interventions. Choice D, Assessment, is the initial step in the nursing process that involves collecting data to identify the patient's needs and health status.