Nokea
The nurse is teaching a client with a new diagnosis of Parkinson’s disease about levodopa-carbidopa (Sinemet). Which of the following instructions should the nurse include?
- A. Take the medication with a high-protein meal
- B. Report any uncontrolled movements
- C. Stop the medication if symptoms improve
- D. Avoid regular neurological exams
Correct Answer: B
Rationale: Uncontrolled movements, such as dyskinesias, are a side effect of levodopa-carbidopa, requiring dose adjustment. Options A, C, and D are incorrect: high-protein meals reduce absorption, stopping the medication risks symptom return, and exams are essential.
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Which of the following guidelines is appropriate for the nurse to give a mother concerning the developmental stage of her seven-year-old daughter?
- A. The child's periods of shyness are to be expected.
- B. Nightmares are not characteristic of this age and should be investigated.
- C. The child should be encouraged to care for her younger sister.
- D. Punishment may be necessary for acts of independence.
Correct Answer: A
Rationale: normal for developmental stage, beginning to show independence from parents
The nurse is caring for a client with a history of hypothyroidism.
- A. Which symptom is expected in a client with untreated hypothyroidism?
- B. Weight loss and irritability.
- C. Cold intolerance and fatigue.
- D. Tachycardia and heat intolerance.
- E. Diarrhea and restlessness.
Correct Answer: B
Rationale: Cold intolerance and fatigue are classic symptoms of hypothyroidism due to slowed metabolism. Weight loss, tachycardia, and diarrhea are associated with hyperthyroidism.
A four-week-old infant with symptoms of pyloric stenosis is brought to the outpatient clinic by his mother. Which of the following statements would the nurse expect the mother to make about her son's symptoms?
- A. My son's bowel movements have turned black and sticky.
- B. I really have to encourage my son to suck the bottle.
- C. My son is fussy and seems hungry all the time.
- D. My son spits up green liquid after feeding.
Correct Answer: C
Rationale: becomes lethargic, dehydrated, and malnourished
The nurse is caring for a client in the ICU. Hemodynamic monitoring is accomplished via a Swan-Ganz catheter. The nurse is aware that this type of monitoring will provide which of the following information?
- A. Measures the circulatory volume in the coronary arteries.
- B. Indirectly measures the pressure in the ventricles.
- C. Analyzes the adequacy of pulmonary circulation.
- D. Directly measures the adequacy of CO2 exchange.
Correct Answer: B
Rationale: CVP readings measure the pressure in the right ventricle, the Swan-Ganz catheter measures the pulmonary artery wedge pressure, which is an indirect reading of the pressure in the left ventricle
A client comes to the nurse's station for her antipsychotic medication. The nurse notes that the client has torticollis, an arched back, and rapid movement of the eyes.
Which of the following action should the nurse take FIRST?
- A. Determine what other medications the patient is taking.
- B. Perform a neurological assessment.
- C. Administer haloperidol decanoate (Haldol D) IM stat.
- D. Administer the PRN trihexyphenidyl (Artane) IM immediately.
Correct Answer: D
Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require validation? No. Determine the outcome of each implementation. (1) assessment, demonstrating acute extrapyramidal side effects (2) assessment, no validation required (3) Haldol is antipsychotic, will exacerbate symptoms (4) correct-administer Cogentin or Artane