Nokea
The nurse is caring for a client with a history of myasthenia gravis. Which medication should the nurse anticipate being prescribed?
- A. Pyridostigmine (Mestinon)
- B. Phenytoin (Dilantin)
- C. Propranolol (Inderal)
- D. Methotrexate (Rheumatrex)
Correct Answer: A
Rationale: Pyridostigmine, a cholinesterase inhibitor, is used to treat myasthenia gravis by improving neuromuscular transmission. The other medications are for seizures, hypertension, or arthritis, not myasthenia.
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Which task should be delegated to the licensed practical nurse?
- A. Administering heparin subcutaneously
- B. Feeding the client with a percutaneous endoscopy gastrostomy tube
- C. Removing a peripherally inserted central line
- D. Monitoring chest tube drainage
- E. Performing tracheostomy care
Correct Answer: A, B, D, E
Rationale: LPNs can administer subcutaneous heparin (A), feed via PEG tube (B), monitor chest tubes (D), and perform tracheostomy care (E). Removing a PICC line (C) requires RN-level expertise due to potential complications.
Which of the following is not a step in primary assessment of a client presenting to the emergency department after being involved in a motor vehicle accident?
- A. Assessing and maintaining a patent airway
- B. Obtaining vital signs
- C. Using the Glasgow Coma Scale to check responsiveness
- D. Controlling bleeding
Correct Answer: B
Rationale: Primary assessment in trauma follows the ABCDE approach (Airway Breathing Circulation Disability Exposure). Obtaining vital signs is part of the secondary assessment not the primary survey which focuses on immediate life threats like airway bleeding and responsiveness.
Which finding is considered a risk factor in the development of leukemia?
- A. The client is an avid stamp collector.
- B. The client works as a computer programmer.
- C. The client had radiation for Hodgkin's lymphoma.
- D. The client's grandmother had stomach cancer.
Correct Answer: C
Rationale: Radiation exposure such as from treatment for Hodgkin’s lymphoma is a known risk factor for leukemia. Stamp collecting computer programming and a family history of stomach cancer are not established risk factors.
An 11-year-old boy has received a partial-thickness burn to both legs. He presents to the emergency room approximately 15 minutes after the accident in excruciating pain with charred clothing to both legs. What is the first nursing action?
- A. Apply ice packs to both legs.
- B. Begin débridement by removing all charred clothing from wound.
- C. Apply Silvadene cream (silver sulfadiazine).
- D. Immerse both legs in cool water.
Correct Answer: D
Rationale: Emergency care of a thermal burn is immersing both legs in cool water. Cool water permits gradual temperature change and prevents further thermal damage.
An obstructing stone in the renal pelvis or upper ureter causes:
- A. Radiating pain into the urethra with labia pain experienced in females or testicular pain in males
- B. Urinary frequency and dysuria
- C. Severe flank and abdominal pain with nausea, vomiting, diaphoresis, and pallor
- D. Dull, aching, back pain
Correct Answer: C
Rationale: Radiating pain in the urethra in both sexes, extending into the labia in females and into the testicle or penis in the male, indicates a stone in the middle or lower segment of the ureter. Urinary frequency and dysuria are caused by a stone in the terminal segment of the ureter within the bladder wall. An obstructing stone in the renal pelvis or upper ureter causes severe flank and abdominal pain with nausea, vomiting, diaphoresis, and pallor. Dull and aching pain may indicate early stages of hydronephrosis. Also, a stone in the renal pelvis or upper ureter causes severe flank and abdominal pain.