Nokea
The nurse is caring for a client who has just undergone a total knee replacement. Which of the following interventions is most important in the immediate postoperative period?
- A. Encourage weight-bearing on the affected leg.
- B. Apply ice packs to the surgical site.
- C. Keep the leg in a dependent position.
- D. Limit range-of-motion exercises.
Correct Answer: B
Rationale: Applying ice packs reduces swelling and pain post-knee replacement, promoting recovery.
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A client has been given a prescription for propantheline as adjunctive treatment for peptic ulcer disease. How should the nurse tell the client to take this medication?
- A. With meals
- B. With antacids
- C. Just after meals
- D. Thirty minutes before meals
Correct Answer: D
Rationale: Propantheline is an antimuscarinic anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes before meals to reduce acid secretion before food intake stimulates gastric acid production. Administering with meals or just after meals would reduce its effectiveness, and taking it with antacids could interfere with its absorption.
A client with a history of seizures is prescribed phenytoin (Dilantin). The nurse should instruct the client to report which of the following side effects?
- A. Gingival hyperplasia
- B. Weight gain
- C. Insomnia
- D. Dry skin
Correct Answer: A
Rationale: Phenytoin can cause gingival hyperplasia, which requires monitoring and dental care. Weight gain, insomnia, and dry skin are not common side effects.
A client has been prescribed metoprolol for hypertension. The nurse monitors client compliance carefully because of which common side effect of the medication?
- A. Impotence
- B. Mood swings
- C. Increased appetite
- D. Complete atrioventricular (AV) block
Correct Answer: A
Rationale: A common side effect of beta-adrenergic blocking agents, such as metoprolol, is impotence. Other common side effects include fatigue and weakness. Central nervous system side effects occur rarely and include mental status changes, nervousness, depression, and insomnia. Mood swings, increased appetite, and complete AV block are not reported side effects.
A client is scheduled for a colonoscopy. Which of the following instructions should the nurse include in the pre-procedure teaching?
- A. Avoid solid foods for 24 hours before the procedure.
- B. Take all regular medications the morning of the procedure.
- C. Expect to be sedated during the procedure.
- D. Plan to stay overnight in the hospital.
Correct Answer: A, C
Rationale: Clear liquid diet for 24 hours prevents residue, and sedation is common during colonoscopy. Regular medications may need adjustment, and overnight stays are not typical.
Select the step of blood glucose level monitoring that is NOT accurate.
- A. Turn the finger down so the blood will drop with gravity.
- B. Wipe off the first drop of blood using sterile gauze.
- C. Prick the side of the finger using the lancet.
- D. Prick the pad of the finger using the lancet.
Correct Answer: D
Rationale: Pricking the pad of the finger is less accurate and more painful; the side of the finger is the preferred site for blood glucose monitoring.