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The nurse is reinforcing teaching to an overweight 54-year-old client about ways to decrease symptoms of obstructive sleep apnea. Which interventions would be most effective? Select all that apply.
- A. Eating a high-protein snack at bedtime
- B. Limiting alcohol intake
- C. Losing weight
- D. Taking a mild sedative at bedtime
- E. Taking a nap during the day
- F. Taking modafinil at bedtime
Correct Answer: B,C
Rationale: Limiting alcohol (B) reduces airway relaxation, and losing weight (C) decreases airway obstruction, both directly alleviating sleep apnea symptoms.
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A client has just been diagnosed with diabetes and is admitted for insulin regulation. The client asks the nurse, 'Why do I need to be stuck so many times per day?' Which of the following statements best explains the rationale for checking the client's blood glucose level frequently?
- A. Blood glucose levels need to be checked every hour to ensure constant insulin needs.'
- B. Any fluctuation in blood glucose levels must be avoided.'
- C. Blood glucose levels are checked to be able to adjust the dosage of your insulin.'
- D. Elevations in glucose can result in alkalosis.'
Correct Answer: C
Rationale: Frequent blood glucose checks allow for insulin dose adjustments to maintain glycemic control. Hourly checks are excessive, fluctuations are managed not avoided, and alkalosis is unrelated to glucose elevations.
The nurse is caring for a client who is experiencing status epilepticus and does not have a peripheral venous access device. Which of the following actions should the nurse take first?
- A. Administer rectal diazepam.
- B. Transport the client for a CT scan.
- C. Obtain a blood specimen for complete blood count.
- D. Check the client for neck stiffness and Brudzinski sign.
Correct Answer: A
Rationale: Rectal diazepam is a first-line treatment for status epilepticus when IV access is unavailable, as it rapidly terminates seizures to prevent brain damage.
A woman is scheduled for an electromyography procedure (EMG) in the outpatient department. What should the nurse say to the woman?
- A. Do not eat or drink anything after midnight the night before the procedure.'
- B. Are you allergic to shellfish or iodine?'
- C. Do not eat or drink anything that contains caffeine for two to three days before the procedure.'
- D. There is no special preparation for this procedure.'
Correct Answer: D
Rationale: EMG requires no special preparation, as it involves muscle and nerve testing without fasting, allergies, or caffeine restrictions.
The nurse is reviewing prescriptions for assigned adult clients. The nurse should question the prescription for
- A. 0.45% sodium chloride for a client with syndrome of inappropriate antidiuretic hormone secretion who has a decreased sodium level
- B. 0.9% sodium chloride for a client with gastrointestinal bleeding who has a decreased hemoglobin level
- C. 1,000 mL bolus of 0.9% sodium chloride for a client with septic shock who has an increased WBC count
- D. lactated Ringer solution for a client with hypovolemic shock and a thermal burn who has an increased hematocrit level
Correct Answer: A
Rationale: 0.45% sodium chloride is hypotonic and can worsen hyponatremia in SIADH by further diluting serum sodium, requiring clarification for a hypertonic solution.
The nurse is talking with a client who has urge incontinence and is receiving tolterodine. It would require immediate follow-up if the client reports
- A. straining to have a bowel movement
- B. going an entire workday without needing to urinate
- C. using over-the-counter artificial saliva products for dry mouth
- D. experiencing occasional dizziness in the morning and with position changes
Correct Answer: B
Rationale: Not urinating for an entire workday suggests urinary retention, a serious side effect of tolterodine, requiring immediate evaluation to prevent bladder damage.