Nokea
The nurse is caring for a client with chronic liver disease. Which lab value is most concerning?
- A. Elevated AST and ALT
- B. Decreased albumin level
- C. Elevated bilirubin level
- D. Prolonged PT/INR
Correct Answer: D
Rationale: The correct answer is D, prolonged PT/INR. In a client with chronic liver disease, a prolonged PT/INR is the most concerning lab value. This indicates impaired liver function, leading to a higher risk of bleeding. Elevated AST and ALT (choice A) are indicators of liver damage but do not directly assess the risk of bleeding. Decreased albumin level (choice B) reflects impaired liver function but is not as directly related to bleeding risk as a prolonged PT/INR. Elevated bilirubin level (choice C) is a sign of liver dysfunction, specifically related to bile metabolism, and while important, it is not as directly associated with bleeding risk as a prolonged PT/INR in the context of chronic liver disease.
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The nurse explains the 2-week dosage prescription of prednisone (Deltasone) to a client who has poison ivy over multiple skin surfaces. What should the nurse emphasize about the dosing schedule?
- A. Decrease the dosage daily as prescribed
- B. Monitor oral temperature daily
- C. Take the prednisone with meals
- D. Return for blood glucose monitoring in one week
Correct Answer: A
Rationale: The correct answer is A: 'Decrease the dosage daily as prescribed.' Tapering the dosage of prednisone is crucial to prevent withdrawal symptoms and minimize the side effects of corticosteroid therapy. Decreasing the dosage gradually over time allows the body to adjust and reduces the risk of adrenal insufficiency. Choices B, C, and D are incorrect. Monitoring oral temperature daily, taking prednisone with meals, or returning for blood glucose monitoring in one week are not specific to the dosing schedule of prednisone for poison ivy treatment.
A client with hypothyroidism is taking levothyroxine (Synthroid). Which symptom should prompt the nurse to notify the healthcare provider?
- A. Weight gain
- B. Bradycardia
- C. Nervousness and tremors
- D. Fatigue
Correct Answer: C
Rationale: The correct answer is C: Nervousness and tremors. These symptoms may indicate hyperthyroidism resulting from excessive dosing of levothyroxine. Weight gain (Choice A) is a common symptom of hypothyroidism and may indicate undertreatment or inadequate dosing. Bradycardia (Choice B) is a symptom of hypothyroidism and may improve with levothyroxine therapy; it does not typically indicate an urgent need for healthcare provider notification. Fatigue (Choice D) is a symptom of hypothyroidism and can persist even with levothyroxine treatment, so it is not a symptom that would require immediate notification of the healthcare provider.
A client with a history of seizures is being discharged home. Which instruction is most important for the nurse to provide?
- A. Take your medication as prescribed.
- B. Avoid driving until your condition is stable.
- C. Keep a seizure diary.
- D. Avoid alcohol consumption.
Correct Answer: A
Rationale: The most important instruction for a client with a history of seizures being discharged home is to take their medication as prescribed. Consistent and timely intake of anti-seizure medication is vital in managing seizures and preventing episodes. While instructions like avoiding driving until the condition is stable, keeping a seizure diary, and avoiding alcohol consumption are important, none are as critical as ensuring proper medication adherence to control seizures effectively. Failure to take prescribed medications can lead to breakthrough seizures, compromising the patient's safety and seizure control.
What should the nurse prioritize when providing discharge instructions to a client with a new colostomy?
- A. Skin care around the stoma site
- B. The schedule for colostomy bag replacement
- C. Techniques for odor control
- D. Dietary modifications
Correct Answer: A
Rationale: Correct answer: Skin care around the stoma site. Proper skin care around the stoma site is crucial for preventing skin irritation and infection, which are common issues for patients with new colostomies. While the schedule for colostomy bag replacement (Option B) is important, it is not the priority during initial discharge instructions. Techniques for odor control (Option C) are relevant but secondary to skin care for a new colostomy. Dietary modifications (Option D) may be discussed later but are not the priority at this stage.
The nurse is assessing a newborn and notes that the infant has a yellowish tint to the skin. What should the nurse do next?
- A. Reassure the parents that this is normal
- B. Monitor the infant's bilirubin levels
- C. Increase the frequency of feedings
- D. Administer phototherapy
Correct Answer: B
Rationale: When a newborn presents with a yellowish tint to the skin, it can indicate jaundice, which is caused by elevated bilirubin levels. Monitoring the infant's bilirubin levels is crucial to assess the severity of jaundice and determine the need for further intervention. Reassuring the parents without proper assessment could lead to delayed treatment if jaundice is present. Increasing the frequency of feedings may not address the underlying cause of jaundice. Administering phototherapy is a treatment option that should be based on bilirubin level assessment and healthcare provider's recommendation.