Nokea
The nurse is caring for a client with a history of psoriasis. The nurse should expect the client to have:
- A. Scaly plaques
- B. Joint swelling
- C. Fever
- D. Chest pain
Correct Answer: A
Rationale: Psoriasis causes scaly, silvery plaques due to rapid skin cell turnover, a hallmark symptom.
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A 1-year-old child is to receive an IM injection ordered by his pediatrician. He has fallen asleep in his mother's arms when the nurse approaches. Which approach is most appropriate at this time?
- A. Give the injection in the vastus lateralis site before the child awakens.
- B. Awaken the child first and give the injection in the ventrogluteal site.
- C. Awaken the child first and give the injection in the dorsogluteal site.
- D. Ask the mother to place the child on the examination table and leave the room, and then give the injection in an appropriate site.
Correct Answer: B
Rationale: If awakened first, the child will know that nothing painful will be done without the child being alerted. The ventrogluteal site is a safe site for children because it is a large muscle free of major nerves and blood vessels. The dorsogluteal site is not recommended in children who have not been walking for at least 1 year because the muscle is not fully developed. The parent will be able to offer support and comfort during and after the injection.
A client requires log rolling after back surgery. Correctly provide the sequence of steps the nurse should follow when performing the procedure.
- A. Obtain assistance; three nurses are preferable.
- B. Maintain client's position in alignment with pillows.
- C. Position two nurses on the side the client will be turned to and the third nurse on the opposite side of the bed.
- D. Designate the person at the head of the bed to be in charge of coordinating the move.
- E. Place a pillow between the client's knees.
- F. Move the client in one coordinated movement when the nurse at the head of the bed signals to move the client.
- G. Instruct the client to place the arms across the chest.
Correct Answer: A, C, D, G, E, B, F
Rationale: Log rolling sequence: Obtain assistance (A), position nurses (C), designate leader (D), instruct arm placement (G), place pillow (E), align with pillows (B), move coordinately (F).
A client is being discharged with albuterol (Proventil) and beclomethasone dipropionate (Vanceril) to be administered via inhalation three times a day and at bedtime. Client teaching regarding the sequential order in which the drugs should be administered includes:
- A. Glucocorticoid followed by the bronchodilator
- B. Bronchodilator followed by the glucocorticoid
- C. Alternate successive administrations
- D. According to the client's preference
Correct Answer: B
Rationale: The client would not receive therapeutic effects of the glucocorticoid when it is inhaled through constricted airways. Bronchodilating the airways first allows for the glucocorticoid to be inhaled through open airways and increases the penetration of the steroid for maximum effectiveness of the drug. Inaccurate use of the inhalers will lead to decreased effectiveness of the treatment. Client teaching regarding the use and effects of inhalers will promote client understanding and compliance.
A 74-year-old female client is 3 days postoperative. She has an indwelling catheter and has been progressing well. While the nurse is in the room, the client states, 'Oh dear, I feel like I have to urinate again!' Which of the following is the most appropriate initial nursing response?
- A. Assure her that this is most likely the result of bladder spasms.
- B. Check the collection bag and tubing to verify that the catheter is draining properly.
- C. Instruct her to do Kegel exercises to diminish the urge to void.
- D. Ask her if she has felt this way before.
Correct Answer: B
Rationale: The most frequent reason for an urge to void with an indwelling catheter is blocked tubing, so checking the catheter's patency is the best initial response.
A client with multiple sclerosis has an order to receive Solu Medrol 200mg IV push. The available dose is Solu Medrol 250 mg per mL. How many mL should the nurse administer?
Correct Answer: 0.8
Rationale: Dose: 200 mg ÷ 250 mg/mL = 0.8 mL. The nurse should administer 0.8 mL.