Nokea
The nurse is caring for a client with a history of sickle cell disease.
- A. Which intervention is most effective during a sickle cell crisis?
- B. Administer oxygen therapy.
- C. Encourage ambulation.
- D. Apply cold compresses to painful areas.
- E. Restrict fluid intake.
Correct Answer: A
Rationale: Oxygen therapy improves oxygenation, reducing sickling and tissue hypoxia during a sickle cell crisis. Ambulation is limited, cold compresses worsen vasoconstriction, and fluids are encouraged to prevent dehydration.
You may also like to solve these questions
The client is scheduled for a myelogram today. The permit has been signed. The client tells the nurse that she has changed her mind and does not want to have the procedure. What should the nurse do?
- A. Tell the client that once permission has been given, the procedure has to be done
- B. Tell the client that the physician will be very upset if she does not have it done
- C. Suggest to the client that it is in her best interests to have the procedure as scheduled
- D. Understand that the client has the right to change her mind about procedures
Correct Answer: D
Rationale: Clients have the right to withdraw consent at any time, respecting autonomy. Coercion or suggesting physician displeasure is unethical.
A nurse is teaching a client about self-administration of Haldol 15 mg po hs. For which side effect/s must the client seek medical attention?
- A. SOB and fatigue
- B. restlessness and muscle spasms
- C. dry mouth
- D. diarrhea
Correct Answer: B
Rationale: Muscle spasms and restlessness are side effects of Haldol.
A 68-year-old client has an order for hydrochlorothiazide (Hydrodiuril) 50 mg qd. The nurse knows that teaching has been successful if the client makes which of the following statements?
- A. I should not operate heavy machinery.
- B. I should drink only five glasses of liquid per day.
- C. This medication will cause my urine to turn orange.
- D. I should eat dried apricots each day.
Correct Answer: D
Rationale: Hydrochlorothiazide causes potassium loss; eating potassium-rich apricots indicates understanding. Options A, B, and C are incorrect.
A client with bipolar disorder receives Eskalith (lithium carbonate) bid. Which observation is associated with lithium toxicity?
- A. Hyporeflexia
- B. Akathesia
- C. Ataxia
- D. Petechiae
Correct Answer: C
Rationale: Ataxia , or impaired coordination, is a sign of lithium toxicity. Hyporeflexia is not typical. Akathesia is restlessness, often linked to antipsychotics. Petechiae indicate bleeding issues, not lithium toxicity.
The nurse is caring for a client who is receiving IV fluids at 150 mL/hour. Which of the following findings indicates fluid overload?
- A. Blood pressure of 120/80 mmHg.
- B. Heart rate of 80 bpm.
- C. Crackles in the lung bases.
- D. Urine output of 50 mL/hour.
Correct Answer: C
Rationale: Crackles in the lung bases suggest pulmonary edema from fluid overload. Options A, B, and D are normal findings.