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The nurse is reviewing new medication prescriptions for a client who has a suspected brain tumor. The client is scheduled for a CT scan of the head with IV iodinated contrast in 24 hours. The nurse should clarify the prescription for
- A. gabapentin
- B. amlodipine
- C. metformin
- D. phenytoin
Correct Answer: C
Rationale: Metformin should be held before and after iodinated contrast due to the risk of lactic acidosis if contrast-induced kidney injury occurs. Gabapentin, amlodipine, and phenytoin are safe with contrast.
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The primary nursing diagnosis for a client with congestive heart failure with pulmonary edema is
- A. Pain
- B. Impaired gas exchange
- C. Cardiac output altered: decreased
- D. Fluid volume excess
Correct Answer: C
Rationale: Cardiac output altered: decreased. Increasing cardiac output is the primary goal of therapy, improving comfort and respiratory status.
A client tells the RN she has decided to stop taking sertraline (Zoloft) because she doesn't like the nightmares, sex dreams, and obsessions she's experiencing since starting on the medication. What is an appropriate response by the nurse?
- A. It is unsafe to abruptly stop taking any prescribed medication.'
- B. Side effects and benefits should be discussed with your health care provider.'
- C. This medication should be continued despite unpleasant symptoms.'
- D. Many medications have potential side effects.'
Correct Answer: A
Rationale: Abrupt withdrawal may occasionally cause serotonin syndrome, consisting of lethargy, nausea, headache, fever, sweating, and chills. A slow withdrawal may be prescribed with sertraline to avoid dizziness, nausea, vomiting, and diarrhea.
A registered nurse (RN) is assigned to work at the Poison Control Center telephone hotline. In which of these cases of childhood poisoning would the nurse suggest that parents have the child drink orange juice?
- A. An 18 month-old who ate an undetermined amount of crystal drain cleaner
- B. A 14 month-old who chewed 2 leaves of a philodendron plant
- C. A 20 month-old who is found sitting on the bathroom floor beside an empty bottle of diazepam (Valium)
- D. A 30 month-old who has swallowed a mouthful of charcoal lighter fluid
Correct Answer: A
Rationale: An 18 month-old who ate an undetermined amount of crystal drain cleaner. Orange juice is acidic and will help neutralize the alkaline drain cleaner.
The nurse is caring for a client who had thoracic surgery yesterday and has a chest tube attached to water seal drainage. The client's family asks why he has to have a chest tube. What should the nurse include in the response?
- A. The chest tube allows air to enter the thoracic cavity to equalize pressures in the lung.
- B. The chest tube removes air from the pleural cavity and promotes reexpansion of the lung.
- C. The chest tube increases the amount of oxygen available to the lungs.
- D. The chest tube will help the wound heal faster and reduce scarring.
Correct Answer: B
Rationale: Chest tubes remove air/fluid from the pleural cavity, allowing lung reexpansion post-thoracic surgery. Other options misrepresent the tube's function.
The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the client’s caregiver?
- A. Administer the medication around the clock even if the client denies having pain
- B. Avoid administering with immediate-release opioids to prevent respiratory depression
- C. Change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs
- D. Request a tapered dose from the health care provider if pain decreases to prevent tolerance
Correct Answer: A
Rationale: Around-the-clock dosing maintains pain control in cancer, preventing peaks and troughs. Combining with immediate-release opioids is common, dosage changes require provider orders, and tapering is less critical in terminal care.