Nokea
The nurse is teaching a client with a new diagnosis of epilepsy about safety precautions. Which of the following instructions is most important?
- A. Avoid swimming alone.
- B. Take medications at bedtime only.
- C. Use a soft toothbrush.
- D. Limit fluid intake.
Correct Answer: A
Rationale: Avoiding swimming alone is critical for safety in epilepsy to prevent drowning during a seizure.
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A client has been defibrillated at 360 joules (monophasic) and the attempts to convert the ventricular fibrillation (VF) were unsuccessful. Based on an evaluation of the situation, the nurse determines that which action is best?
- A. Terminating the resuscitation effort
- B. Preparing for the administration of sodium bicarbonate intravenously
- C. Performing cardiopulmonary resuscitation (CPR) for 5 cycles or about 2 minutes
- D. Performing CPR for 5 minutes, then defibrillating 3 more times at 400 joules
Correct Answer: C
Rationale: Defibrillation is an asynchronous countershock used to terminate pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). The defibrillator is charged to 120 to 200 joules (biphasic) or 300 joules (monophasic) for 1 countershock from the defibrillator, and then CPR is immediately resumed and continued for 5 cycles or about 2 minutes. The rhythm is reassessed after 2 minutes and if VF or pulseless VT continues, the defibrillator is charged to give a second shock at the same energy level previously used. CPR is resumed after the shock if needed and the life support protocol is continued. There is no information in the question to indicate that life support should be terminated. Sodium bicarbonate may be prescribed but is not the best action. Giving CPR for 5 minutes may not help oxygenation to the brain and myocardium and is not the best action.
A client with a history of chronic kidney disease is prescribed sodium polystyrene sulfonate (Kayexalate). The nurse should explain that this medication works by:
- A. Reducing blood pressure.
- B. Binding potassium in the gut.
- C. Increasing urine output.
- D. Decreasing blood glucose.
Correct Answer: B
Rationale: Sodium polystyrene sulfonate binds potassium in the gut, reducing serum potassium levels in chronic kidney disease.
The nurse should give which medication instructions to the client prescribed quinapril hydrochloride?
- A. Take the medication with food only.
- B. Expect a therapeutic effect immediately.
- C. Discontinue the medication if nausea occurs.
- D. Rise slowly from a lying to a sitting position.
Correct Answer: D
Rationale: Quinapril hydrochloride is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. A full therapeutic effect may be noted in 1 to 2 weeks. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast.
The nurse has received the client assignment for the day. Which client should the nurse care for first?
- A. A client with a wound infection who has a temperature of 100.4°F
- B. A client with a deep vein thrombosis who reports bleeding gums when brushing the teeth
- C. A client who had a right arm casted 12 hours ago who is complaining of numbness in the fingers
- D. A client with chronic obstructive pulmonary disease (COPD) who has a respiratory rate of 22 beats per minute
Correct Answer: C
Rationale: The client with a cast who experiences numbness in the fingers should be seen first because this could be a symptom of compartment syndrome. Compartment syndrome creates an emergency situation when it does occur. Within 4 to 6 hours after the onset of compartment syndrome, neurovascular and muscle damage are irreversible if treatment is not provided. The limb can become useless in 24 to 48 hours. It would be expected that the client with a wound infection will have an elevation in body temperature. A client on anticoagulant therapy for treatment of a deep vein thrombosis who experiences bleeding gums when brushing teeth should be evaluated but is not the priority. A respiratory rate of 22 breaths per minute in the client with COPD is considered normal.
A client with a diagnosis of Parkinson's disease is prescribed levodopa-carbidopa (Sinemet). The nurse should teach the client that this medication works by:
- A. Reducing muscle spasms.
- B. Increasing dopamine levels in the brain.
- C. Blocking acetylcholine receptors.
- D. Decreasing serotonin levels.
Correct Answer: B
Rationale: Levodopa-carbidopa increases dopamine levels in the brain, helping to alleviate Parkinson's symptoms.