Nokea
The nurse is teaching a client with a new diagnosis of glaucoma about eye drop administration. Which of the following instructions should the nurse include?
- A. Apply pressure to the inner canthus after instilling drops.
- B. Instill the drops directly onto the cornea.
- C. Shake the bottle vigorously before use.
- D. Store the drops in the refrigerator.
Correct Answer: A
Rationale: applying pressure to the inner canthus (nasolacrimal occlusion) prevents systemic absorption of the medication
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The mother of a 24-month-old child tells the nurse that she is concerned that her child's language abilities are delayed. Which of the following language milestones does the nurse expect the child to exhibit?
- A. Understands 300 words and uses two- and three-word sentences.
- B. Says and understands a few words, such as 'Mama' and 'Dada,' and can imitate animal sounds, such as 'moo' and 'woof.'
- C. Says and understands four to six words but understands more and can point to items he wants.
- D. Says and understands up to 20 words and can point to his body parts.
Correct Answer: A
Rationale: A 24-month-old should understand about 300 words and use two- to three-word sentences (A). Other options (B, C, D) describe earlier developmental stages.
The charge nurse is making an assignment for an LPN on an upcoming shift. Which assignment would be appropriate?
- A. a client with a recent head injury and active seizures
- B. a post-operative patient requiring vital sign monitoring every hour
- C. a post-operative patient receiving a blood transfusion
- D. a client with diabetes requiring discharge instruction on insulin injection
Correct Answer: B
Rationale: Vital sign monitoring is within the LPN’s scope. Seizure management, blood transfusions, and discharge teaching require RN expertise.
Which vitamin should be administered with INH (isoniazid) in order to prevent possible nervous system side effects?
- A. Thiamine
- B. Niacin
- C. Pyridoxine
- D. Riboflavin
Correct Answer: C
Rationale: Pyridoxine (vitamin B6) is given with isoniazid to prevent peripheral neuropathy, a potential side effect of the medication.
Which of the following pediatric clients is at greatest risk for latex allergy?
- A. The child with a myelomeningocele
- B. The child with epispadias
- C. The child with coxa plana
- D. The child with rheumatic fever
Correct Answer: A
Rationale: Children with myelomeningocele are at higher risk for latex allergy due to repeated exposure to latex products during medical procedures.
A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?
- A. Hypernatremia
- B. Hypokalemia
- C. Myelosuppression
- D. Leukocytosis
Correct Answer: B
Rationale: A potassium level of 1.9 mEq/L indicates hypokalemia, which is a critical electrolyte imbalance.