Nokea
The nurse is caring for a client with asthma who has developed gastroesophageal reflux disease (GERD). Which of the following medications prescribed for the client may aggravate GERD?
- A. Anticholinergics
- B. Corticosteroids
- C. Histamine blocker
- D. Antibiotics
Correct Answer: A
Rationale: An anticholinergic medication will decrease gastric emptying and the pressure on the lower esophageal sphincter.
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The nurse is caring for a client who is receiving IV gentamicin for a gram-negative infection. Which of the following laboratory results would be of GREATest concern to the nurse?
- A. Creatinine 2.5 mg/dL.
- B. Sodium 140 mEq/L.
- C. Potassium 4.0 mEq/L.
- D. Hemoglobin 13 g/dL.
Correct Answer: A
Rationale: A creatinine of 2.5 mg/dL indicates renal impairment, a serious complication of gentamicin due to nephrotoxicity, 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.
During auscultation of the fetal heart rate during labor, the nurse assesses a rate of 59 beats per minute.
The FIRST action the nurse should take is
- A. turn the mother on her right side, increase the intravenous flow rate, and call the physician.
- B. turn the mother on her left side, administer oxygen by nasal cannula, and start an IV.
- C. call the physician, and make preparations for an immediate emergency cesarean section.
- D. position the mother in Trendelenburg's position, administer oxygen, and force fluids.
Correct Answer: B
Rationale: Strategy: 'FIRST' indicates that this is a priority question. All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) should be placed on left side to increase blood flow to the uterus (2) correct-persistent fetal bradycardia may indicate cord compression or separation of the placenta, but always indicates fetal distress, left side reduces compression of vena cava and aorta (3) should be done after positioning patient (4) this position is used only if there is cord prolapsed
The nurse is caring for a client with a history of type 1 diabetes who is receiving insulin detemir (Levemir) 15 units SC daily. Which of the following symptoms should the nurse report immediately?
- A. Mild fatigue
- B. Sweating and shakiness
- C. Occasional thirst
- D. Mild headache
Correct Answer: B
Rationale: Sweating and shakiness indicate hypoglycemia, a medical emergency with insulin detemir. Options A, C, and D are less urgent: fatigue is nonspecific, thirst is expected, and headache is common.
The nurse is caring for a client in the coronary care unit. The display on the cardiac monitor indicates ventricular fibrillation. What should the nurse do first?
- A. Perform defibrillation
- B. Administer epinephrine as ordered
- C. Assess for presence of pulse
- D. Institute CPR
Correct Answer: C
Rationale: Assess for presence of pulse. Verifying the absence of a pulse confirms ventricular fibrillation before proceeding with treatment.
A client is being discharged following insertion of a permanent set pacemaker. A client with a permanent set pacemaker should be taught:
- A. To keep a loose dressing over the insertion site at all times
- B. That the pacemaker will function continuously at a set rate
- C. That increases in activity will require adjustments in the pacemaker setting
- D. That he will have to modify his lifestyle to allow for afternoon rest periods
Correct Answer: C
Rationale: Modern pacemakers adjust their rate based on activity (rate-responsive pacing), so the client should understand that increased activity may require pacemaker adjustments.