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The nurse is caring for a client with a history of epilepsy who is receiving carbamazepine (Tegretol) 200 mg PO bid. Which of the following laboratory results would be of GREATest concern to the nurse?
- A. White blood cell count of 3,000/mm^3.
- B. Sodium 140 mEq/L.
- C. Potassium 4.0 mEq/L.
- D. Hemoglobin 13 g/dL.
Correct Answer: A
Rationale: A white blood cell count of 3,000/mm^3 indicates leukopenia, a serious side effect of carbamazepine, increasing infection risk and requiring immediate evaluation. Options B, C, and D are normal: sodium 140 mEq/L, potassium 4.0 mEq/L, and hemoglobin 13 g/dL do not indicate complications.
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A woman comes to the antepartum clinic for a routine prenatal examination. She is 12 weeks pregnant with her second child. Which of the following shows proper documentation of the client's obstetric history by the nurse?
- A. Para 2, Gravida 1
- B. Nulligravida 2, Para 1
- C. Primigravida 1, Para 1
- D. Gravida 2, Para 1
Correct Answer: D
Rationale: Gravida 2, Para 1. Gravida describes a woman who is or has been pregnant, regardless of pregnancy outcome. Para describes the number of babies born past a point of viability.
A child is injured on the school playground and appears to have a fractured leg. The first action the school nurse should take is
- A. call for emergency transport to the hospital
- B. immobilize the limb and joints above and below the injury
- C. assess the child and the extent of the injury
- D. apply cold compresses to the injured area
Correct Answer: C
Rationale: When applying the nursing process, assessment is the first step in providing care. The '5 Ps' of vascular impairment can be used as a guide (pain, pulse, pallor, paresthesia, paralysis).
A client who has had a right below-the-knee amputation refers to himself as 'a freak' and 'old peg-leg.' What initial response by the nurse is most therapeutic?
- A. You are not a freak.'
- B. Lots of people have amputations and live a normal life.'
- C. You feel like a freak.'
- D. You shouldn't say that; you are very attractive.'
Correct Answer: C
Rationale: Reflecting the client's feelings ('You feel like a freak') validates their emotions, promoting therapeutic communication. Denying, normalizing, or reassuring dismisses their distress.
The LPN/LVN is making assignments in a long-term care facility. Staff on duty include another LPN and a new certified nursing assistant. Which client can most safely be assigned to the nursing assistant?
- A. Ms. A., 92 years old, has dementia and advancing congestive heart failure (CHF).
- B. Ms. B., 83 years old, has Alzheimer's and Parkinson's and is ambulatory with assistance.
- C. Mr. C., 76 years old, has just been transferred from an acute care facility where he had a total hip replacement four days ago.
- D. Mr. D., 29 years old, had a closed head injury and is in a semi-vegetative state with a tracheostomy and a gastrostomy.
Correct Answer: B
Rationale: Ms. B's ambulatory status with assistance aligns with CNA tasks like hygiene and transfers, safest for a new CNA compared to complex needs.
The nurse is teaching a client with a new diagnosis of rheumatoid arthritis about methotrexate (Rheumatrex). Which of the following statements by the client indicates a need for further teaching?
- A. I should avoid drinking alcohol while taking this medication.
- B. I should take this medication with food.
- C. I should report any bruising to my doctor.
- D. I should stop this medication if my joints feel better.
Correct Answer: D
Rationale: Stopping methotrexate when joints feel better is incorrect, as rheumatoid arthritis requires ongoing treatment to prevent flares. Options A, B, and C are correct: alcohol increases hepatotoxicity, food reduces GI upset, and bruising may indicate thrombocytopenia.