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The nurse is teaching a client with a new diagnosis of hypertension about lifestyle modifications. Which of the following recommendations is most effective?
- A. Increase calcium intake.
- B. Reduce alcohol consumption.
- C. Limit protein intake.
- D. Avoid potassium-rich foods.
Correct Answer: B
Rationale: Reducing alcohol consumption lowers blood pressure by decreasing vascular resistance and fluid retention.
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The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which one of the following results indicates the presence of inflammation?
- A. Decreased sedimentation rate
- B. Thrombocytopenia
- C. Leukocytosis
- D. Erythrocytosis
Correct Answer: C
Rationale: Leukocytosis, an elevated white blood cell count, indicates inflammation or infection. Decreased sedimentation rate, thrombocytopenia, and erythrocytosis are not specific to inflammation.
The nurse is teaching a client with a new diagnosis of rheumatoid arthritis about medication management. Which of the following medications should the client expect to take?
- A. Methotrexate.
- B. Colchicine.
- C. Allopurinol.
- D. Probenecid.
Correct Answer: A
Rationale: Methotrexate is a disease-modifying antirheumatic drug (DMARD) commonly used for rheumatoid arthritis.
A 16-year-old client is in the emergency department for treatment of minor injuries from a car accident. A crisis nurse is with her because she became hysterical and was saying, 'It's my fault. My Mom is going to kill me. I don't even have a way home.' Which of the following should be the nurse's initial intervention?
- A. Hold her hands and say, 'Slow down. Take a deep breath.'
- B. Say, 'Calm down. The police can take you home.'
- C. Put a hand on her shoulder and say, 'It wasn't your fault.'
- D. Say, 'Your mother is not going to kill you. Stop worrying.'
Correct Answer: A
Rationale: This intervention calms the client's hysteria using physical touch and breathing techniques, helping her regain composure before addressing other concerns.
A client with pneumonia is receiving oxygen therapy. The nurse notes cyanosis and a respiratory rate of 32 breaths/min. What should the nurse do first?
- A. Increase the oxygen flow rate.
- B. Notify the physician.
- C. Encourage coughing and deep breathing.
- D. Reposition the client.
Correct Answer: B
Rationale: Cyanosis and tachypnea indicate worsening hypoxia, requiring immediate physician notification to adjust treatment.
The nurse coordinates with the laboratory staff to have the gentamicin trough serum level drawn. At what time should the blood be drawn in relation to the administration of the I.V. dose of gentamicin sulfate [Garamycin]?
- A. 2 hours before the administration of the next I.V. dose.
- B. 3 hours before the administration of the next I.V. dose.
- C. 4 hours before the administration of the next I.V. dose.
- D. Just before the administration of the next I.V. dose.
Correct Answer: D
Rationale: The trough level, which measures the lowest drug concentration, is drawn just before the next dose to ensure the drug is within a therapeutic range and to avoid toxicity.