Nokea
The nurse is caring for a client with an injury to the thalamus. The nurse should plan to:
- A. Give higher doses of pain medication.
- B. Keep patches on the client's eyes to prevent corneal abrasion.
- C. Monitor the temperature of the bathwater.
- D. Avoid turning the client.
Correct Answer: C
Rationale: The thalamus regulates body temperature, so an injury may impair thermoregulation. Monitoring bathwater temperature prevents burns or discomfort. Pain medication, eye patches, or avoiding movement are not directly related to thalamic injury.
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A client with a history of heart failure is admitted with pulmonary edema. The nurse should administer which of the following medications as prescribed? Select all that apply.
- A. Furosemide (Lasix).
- B. Digoxin (Lanoxin).
- C. Nitroglycerin.
- D. Morphine.
- E. Aspirin.
Correct Answer: A, C, D
Rationale: Furosemide reduces fluid overload, nitroglycerin decreases preload, and morphine relieves anxiety and preload in pulmonary edema.
A client with a history of Addison's disease is prescribed hydrocortisone. The nurse should instruct the client to report which of the following side effects immediately?
- A. Weight gain.
- B. Hypoglycemia.
- C. Mood changes.
- D. Muscle weakness.
Correct Answer: C
Rationale: Mood changes may indicate corticosteroid excess, requiring immediate reporting to adjust the hydrocortisone dose.
After a client undergoes a contraction stress test that is negative, which of the following should the nurse assess next?
- A. Evidence of ruptured membranes.
- B. Viability status of the fetus.
- C. Indications that contractions have ceased.
- D. Fetal heart rate variability.
Correct Answer: C
Rationale: A negative contraction stress test indicates no fetal distress, so the nurse should next ensure contractions have ceased to prevent preterm labor. The other assessments are less immediate.
A child diagnosed with tinea is being treated with griseofulvin (Grifulvin V). Which of the following instructions should the nurse give to the parents?
- A. Give the medication before a meal
- B. Have the child avoid intense sunlight
- C. Give the medication for 10 days
- D. Encourage increased fluid intake
Correct Answer: B
Rationale: Griseofulvin increases photosensitivity, so avoiding intense sunlight is critical. It is typically taken with food, requires weeks of treatment, and fluid intake is not specifically needed.
Which intervention would you expect to render to the client in a sickle cell anemia crisis?
- A. The administration of a thrombolytic medication
- B. The administration of hydroxyurea
- C. Placing the client in the Trendelenburg position
- D. Placing the client in the lithotomy position
Correct Answer: B
Rationale: Hydroxyurea is used in sickle cell anemia to reduce the frequency of crises by increasing fetal hemoglobin, which helps prevent sickling of red blood cells.