Nokea
The nurse is teaching a client with a history of kidney stones about dietary modifications. The nurse should tell the client to:
- A. Increase fluid intake
- B. Avoid all calcium
- C. Consume high-oxalate foods
- D. Reduce protein intake
Correct Answer: A
Rationale: Increasing fluid intake dilutes urine, reducing the risk of kidney stone formation.
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The client presents to the clinic with a serum cholesterol of 275 mg/dL and is placed on rosuvastatin (Crestor). Which instruction should be given to the client taking rosuvastatin (Crestor)?
- A. Report unexplained muscle weakness to the physician
- B. Allow six months for the drug to take effect
- C. Take the medication with fruit juice
- D. Report difficulty sleeping
Correct Answer: A
Rationale: Rosuvastatin a statin can cause myopathy or rhabdomyolysis. Unexplained muscle weakness is a serious side effect requiring immediate reporting to prevent complications. The other options are not specific to rosuvastatin therapy.
The nurse is suctioning the tracheostomy of an adult client. The recommended pressure setting for performing tracheostomy suctioning on the adult client is:
- A. 40-60 mmHg
- B. 60-80 mmHg
- C. 80-120 mmHg
- D. 120-140 mmHg
Correct Answer: C
Rationale: Recommended suction pressure for adult tracheostomy is 80-120 mmHg to effectively remove secretions without causing trauma. Higher or lower pressures are less safe or effective.
The nurse is caring for a client with a diagnosis of preterm labor. Which medication is most likely to be ordered?
- A. Betamethasone
- B. Terbutaline
- C. Magnesium sulfate
- D. All of the above
Correct Answer: D
Rationale: Betamethasone promotes fetal lung maturity terbutaline and magnesium sulfate are tocolytics to halt preterm contractions and magnesium may also provide neuroprotection. All are commonly ordered in preterm labor.
A newborn weighing 7 pounds at birth should be expected to weigh pounds by one year of age.
Correct Answer: 21 pounds
Rationale: Newborns typically triple their birth weight by one year. 7 lbs × 3 = 21 lbs.
In working with mental health clients who are prescribed medication that must be taken on a routine basis, it is important for education to begin when the drug therapy is initiated. One of the first steps in the teaching process is to:
- A. Explain the side effects of the medication
- B. Discuss the danger of overmedication
- C. Distribute written material to supplement verbal instructions
- D. Explore the client's perception regarding medication therapy
Correct Answer: D
Rationale: (A, B, C) The nurse must first obtain information regarding the client's perception of the medication regimen. The first step in the teaching process is to determine the client's perception.