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The nurse is providing discharge instructions for a client with metastatic cancer who is prescribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?
- A. Observe bowel movement pattern and take a stool softener.
- B. Watch for signs of agitation and record any insomnia.
- C. Take the benzodiazepine at the same time as taking the morphine.
- D. Do not drink grapefruit juice after taking morphine.
Correct Answer: A
Rationale: Morphine causes constipation, so monitoring bowel movements and using a stool softener demonstrates understanding. Agitation/insomnia, benzodiazepine timing, and grapefruit juice are not primary concerns.
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A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing 'heartburn.' How should the nurse respond?
- A. Ask the client to describe how she takes the medication.
- B. Remind the client to take the medication with plenty of water.
- C. Advise the client to go to the nearest emergency department.
- D. Suggest use of an antacid two hours after the medication.
Correct Answer: A
Rationale: Risedronate can cause esophageal irritation if not taken properly. Assessing the client’s administration technique (e.g., with water, staying upright) identifies potential causes of heartburn, guiding further intervention.
History and physical
The client is a 26-year-old female with acute appendicitis. She has a 12 year history of type 1 diabetes mellitus and no other significant medical history. The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.
Nurses notes
0730
Admitted the client. She is awake and alert. She rates her pain 2 on a 0 to 10 pain scale. Her pulses are equal bilaterally. Heart rate is 76 beats/minute, normal sinus rhythm. Her oxygen saturation is 100% on room air. She has a gauze dressing over her surgical site, which is clean and dry. Her temperature is 98.5° F (37.0° C) orally. She urinated 50 mL upon arrival in the unit and is reporting she
Lab results
Blood glucose 279mg/dl
Orders
Admit to the surgical floor
• Dextrose 5% and 0.9% sodium chloride IV to infuse at 125 mL/hr
Advance diet as tolerated
• Insulin glargine 12 units SUBQ every 24 hours
. Ceftriaxone 2 gram IV piggy back (IVPB) every
24 hours for 3 days, first dose given in surgery
It is 1800, and the client has a scheduled dose of insulin glargine due. The client has a regular diet tray ordered with 60 carbohydrates. The tray has not yet arrived in the room. For each nursing action below, click to specify if the action is indicated, contraindicated or nonessential.Each row must have one option selected.
- A. Give insulin lispro 4 units: Contraindicated
- B. Verify that the client can count carbohydrates: Nonessential
- C. Mix the insulin lispro and insulin glargine in one syringe: Contraindicated
- D. Give insulin glargine 12 units: Indicated
Correct Answer:
Rationale: A: Lispro is contraindicated without meal intake to avoid hypoglycemia. B: Carb counting is nonessential for scheduled glargine. C: Mixing lispro and glargine is contraindicated. D: Glargine is indicated as scheduled.
A client receives a prescription for a secondary infusion of IV erythromycin 1 gram in 200 mL dextrose 5% in water (D5W) to be infused in 90 minutes. The nurse should program the infusion pump to deliver how many mL/hour? (Enter the numerical value only. If rounding is required, round to the nearest whole number.)
Correct Answer: 133
Rationale: Volume = 200 mL, Time = 90 minutes = 1.5 hours. Infusion rate = 200 mL / 1.5 hours = 133.33 mL/hr, rounded to 133 mL/hr.
Levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium?
- A. Constipation.
- B. Decreased appetite.
- C. Restlessness.
- D. Intolerance to cold.
Correct Answer: C
Rationale: Restlessness indicates hyperthyroidism, suggesting excessive levothyroxine. Constipation, decreased appetite, and cold intolerance are hypothyroidism symptoms, not overdose.
A client with a cold is taking the antitussive medication benzonatate. Which assessment information indicates to the nurse that the medication is effective?
- A. Denies having coughing spells.
- B. Able to sleep through the night.
- C. Expectorating bronchial secretions.
- D. Reports reduced nasal discharge.
Correct Answer: B
Rationale: Benzonatate suppresses cough, and sleeping through the night indicates effective cough control. Denying coughing spells is less specific, expectoration relates to expectorants, and nasal discharge is unrelated to antitussive effects.