Nokea
The nurse is assisting the RN with discharge instructions for a client with an implantable defibrillator. What discharge instruction is essential?
- A. "You can eat food prepared in a microwave."?
- B. "You should avoid moving the shoulder on the side of the defibrillator site for 6 weeks."?
- C. "You should use your cellphone on your right side."?
- D. "You will be able to fly on a commercial airliner with the defibrillator in place."?
Correct Answer: C
Rationale: The essential discharge instruction for a client with an implantable defibrillator is to use any battery-operated machinery on the opposite side, including cellphones. This is to prevent interference with the device. Additionally, the client should monitor their pulse rate and report any dizziness or fainting, which could indicate issues with the defibrillator. Choices A, B, and D are incorrect because clients with implantable defibrillators can eat food prepared in the microwave, move their shoulder on the affected side after the initial healing period, and are allowed to fly on commercial airliners with the defibrillator in place.
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How can medication bound to protein affect drug availability?
- A. enhanced drug availability
- B. rapid distribution of the drug to receptor sites
- C. less availability to produce desired medicinal effects
- D. increased metabolism of the drug by the liver
Correct Answer: C
Rationale: Medication bound to protein reduces the availability of the drug to produce desired medicinal effects because only unbound drugs can effectively bind to active receptor sites. When a drug is bound to protein, it cannot bind with receptor sites, limiting its therapeutic impact. Choice A is incorrect because drug availability is reduced when it is bound to protein. Choice B is incorrect as rapid distribution to receptor sites is not possible if the drug is bound to protein and cannot bind with receptors. Choice D is incorrect as metabolism does not increase when the drug is bound to protein; the liver first needs to separate the drug from the protein before metabolism can occur.
A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:
- A. the client's body has developed tolerance, requiring more drug to produce the same effect.
- B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence.
- C. addiction is the term used to describe physical dependence with withdrawal symptoms and tolerance.
- D. the client has a dual diagnosis of substance abuse and chronic back pain
Correct Answer: A
Rationale: Drug tolerance is characterized by the ability to ingest a larger dose without adverse effects and decreased sensitivity to the substance. In this scenario, the client needing an increased dose of hydrocodone to achieve the same pain relief indicates tolerance developing, not addiction. Choice B is incorrect as it describes drug dependence, where the individual is preoccupied with the drug and has a loss of control. Choice C is incorrect because addiction involves psychological behaviors related to substance use, not just physical dependence with withdrawal symptoms and tolerance. Choice D is incorrect as it refers to a dual diagnosis, which is the coexistence of substance abuse and psychiatric disorders, not the development of tolerance to a drug.
Which of the following solutions is routinely used to flush an IV device before and after the administration of blood to a client?
- A. 0.9% sodium chloride
- B. 5% dextrose in water solution
- C. Sterile water
- D. Heparin sodium
Correct Answer: A
Rationale: The correct answer is 0.9% sodium chloride. Normal saline is 0.9% sodium chloride, which has the same osmolarity as blood and does not cause cell lysis. Choices 2 and 3, 5% dextrose in water solution and sterile water, are hypotonic solutions that can lead to cell lysis. Choice 4, Heparin sodium, is an anticoagulant and is not routinely used to flush an IV device before and after the administration of blood.
Six hours after birth, the infant is found to have an area of swelling over the right parietal area that does not cross the suture line. The nurse should chart this finding as:
- A. A cephalohematoma
- B. Molding
- C. Subdural hematoma
- D. Caput succedaneum
Correct Answer: A
Rationale: The correct answer is A, a cephalohematoma. A cephalohematoma is an area of bleeding outside the cranium but beneath the periosteum, typically not crossing the suture line. Answer B, molding, is the overlapping of the bones of the cranium and does not involve bleeding, making it an incorrect choice. Answer C, a subdural hematoma, involves intracranial bleeding and is typically diagnosed through imaging studies like a CAT scan or x-ray. Answer D, caput succedaneum, is characterized by edema that crosses the suture line, unlike the described swelling in this case.
A contraindication for topical corticosteroid use in a client with atopic dermatitis (eczema) is:
- A. parasitic infection
- B. fungal infection
- C. spirochetal infection
- D. viral infection
Correct Answer: D
Rationale: Topical corticosteroids are mainly used for their localized effects. When treating atopic dermatitis with a steroidal preparation, there is a risk of the site being vulnerable to invasion by organisms. Viruses like herpes simplex or varicella zoster pose a threat of disseminated infection. Therefore, viral infection is a contraindication for topical corticosteroid use in clients with atopic dermatitis. It is crucial to educate clients using topical corticosteroids to avoid crowds or people with infections and to promptly report any signs of infection. Choices A, B, and C (parasitic, fungal, and spirochetal infections) are not typically contraindications for topical corticosteroid use in the context of atopic dermatitis, as these agents do not pose the same risk of disseminated infection or systemic effects as viral infections.