Nokea
The nurse is instructing the client on insulin administration. The client is performing a return demonstration for preparing the insulin. The client's morning dose of insulin is 10 units of regular and 22 units of NPH. The nurse checks the dose accuracy with the client. The nurse determines that the client has measured the correct dose when the syringe reads how many units?
Correct Answer: 32 units.
Rationale: The total dose is 10 units regular + 22 units NPH = 32 units, which should be drawn into one syringe for administration.
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A client has sudden, severe pain in his back and chest, accompanied by shortness of breath. The client describes the pain as a 'tearing' sensation. The physician suspects the client is experiencing a dissecting aortic aneurysm. The code cart is brought into the room because one complication of a dissecting aneurysm is:
- A. Cardiac tamponade
- B. Stroke
- C. Pulmonary edema
- D. Myocardial infarction
Correct Answer: A
Rationale: A dissecting aortic aneurysm can rupture into the pericardial space, causing cardiac tamponade, a life-threatening complication requiring emergency intervention (hence the code cart). Stroke, pulmonary edema, and myocardial infarction are less common or indirect complications.
The nurse notices that a client's heart rate decreases from 63 to 50 beats per minute on the monitor. The nurse should first:
- A. Administer Atropine 0.5 mg I.V. push.
- B. Auscultate for abnormal heart sounds.
- C. Prepare for transcutaneous pacing.
- D. Take the client's blood pressure.
Correct Answer: D
Rationale: A heart rate of 50 bpm may indicate bradycardia. Taking the blood pressure first assesses hemodynamic stability, guiding whether immediate intervention (e.g., atropine or pacing) is needed.
A client with an ileal conduit has a rash around the stoma. The nurse should:
- A. Apply a antifungal cream.
- B. Clean with soap and water.
- C. Use a larger appliance.
- D. Cover with gauze.
Correct Answer: B
Rationale: Cleaning with soap and water removes irritants, promoting rash healing.
Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take at home. The nurse should teach the client about which the following adverse effects of this medication?
- A. Retinopathy.
- B. Maculopapular rash.
- C. Nasal congestion.
- D. Dizziness.
Correct Answer: B
Rationale: Maculopapular rash is a common adverse effect of allopurinol, requiring monitoring due to potential allergic reactions.
When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse notes bilateral ankle edema. The edema is related to:
- A. Decreased blood volume
- B. Increase in muscular activity
- C. Increased venous pressure
- D. Increased arterial pressure
Correct Answer: C
Rationale: Bilateral ankle edema in PVD is often due to increased venous pressure from venous insufficiency or right-sided heart failure, which impairs venous return and causes fluid to pool in the lower extremities. Decreased blood volume or increased muscular activity does not cause edema, and arterial pressure is not directly related.