Nokea
The nurse is reinforcing teaching for a client with bipolar disorder who has a new prescription for lithium. Which of the following statements by the client would require follow-up?
- A. I should drink at least 2 to 3 L of fluid daily.'
- B. I can take over-the-counter ibuprofen for pain relief.'
- C. I will maintain a consistent dietary intake of sodium.'
- D. I should have my medication levels checked periodically.'
Correct Answer: B
Rationale: Ibuprofen (B) can increase lithium toxicity, requiring follow-up. Adequate fluid intake (A), consistent sodium (C), and periodic level checks (D) are correct.
You may also like to solve these questions
The nurse is caring for a client who had a colostomy. Which comment by the client indicates that she is showing an interest in learning about her colostomy?
- A. Why did this problem have to happen to me?'
- B. What is the bag of water for?'
- C. When will I get rid of this thing?'
- D. The doctor didn't really do a colostomy.'
Correct Answer: B
Rationale: Asking about the bag's purpose shows curiosity and readiness to learn about colostomy care. Other comments reflect denial, frustration, or lack of engagement.
The nurse has reinforced teaching with a client who has rheumatoid arthritis and is receiving methotrexate. Which of the following statements by the client would require follow-up?
- A. I will avoid drinking alcoholic beverages while taking methotrexate.'
- B. I should take precautions to prevent pregnancy while taking methotrexate.'
- C. I should avoid large crowds and people who are ill while taking methotrexate.'
- D. I will avoid consuming foods high in folic acid that will decrease the effectiveness of methotrexate.'
Correct Answer: D
Rationale: Avoiding alcohol (A), preventing pregnancy (B), and avoiding crowds (C) are correct. Avoiding folic acid (D) is incorrect, as methotrexate often requires folic acid supplementation to reduce side effects.
The nurse is changing a wet to dry dressing. Which action is appropriate?
- A. Pouring sterile solution directly into the wound
- B. Removing the old dressings with sterile gloves
- C. Opening the sterile dressings wearing sterile gloves
- D. Packing the wound wearing sterile gloves
Correct Answer: D
Rationale: Packing the wound with sterile gloves maintains sterility, ensuring proper wet-to-dry dressing application for debridement.
The nurse is assisting the physician with an examination of a client with Addison's disease. During the examination, the nurse will note which change in the client's integumentary system?
- A. Edema of the hands and feet
- B. Hirsutism
- C. Bronze pigmentation
- D. Pendulous abdomen
Correct Answer: C
Rationale: Addison's disease causes bronze pigmentation due to increased ACTH. Edema , hirsutism , and pendulous abdomen are not typical.
The nurse is caring for a frail elderly client in her home. Which behavior, if observed or reported, should the nurse report to the supervisor for further evaluation of possible abuse?
- A. The client's daughter is attempting to be declared her mother's legal guardian.
- B. The client is frequently left in bed alone in the house for several hours at a time.
- C. The client has brown spots on her arms.
- D. The client says, 'My daughter doesn't like me very much. She yells at me.'
Correct Answer: B
Rationale: Leaving a frail client alone for hours poses neglect risk, warranting abuse evaluation. Guardianship, brown spots, or yelling are less definitive without context.