Nokea
The nurse is teaching a client with a new diagnosis of rheumatoid arthritis about methotrexate (Rheumatrex). Which of the following instructions should the nurse include?
- A. Take the medication with grapefruit juice.
- B. Avoid folic acid supplements.
- C. Report any fever or sore throat.
- D. Stop the medication if joint pain decreases.
Correct Answer: C
Rationale: Methotrexate can cause bone marrow suppression; fever or sore throat may indicate infection, requiring reporting. Options A, B, and D are incorrect.
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A 21-year-old primipara in active labor.
The nurse observes a new graduate nurse palpating the uterine contractions of a 21-year-old primipara in active labor. Which of the following actions, if taken by the new graduate nurse, is MOST appropriate?
- A. The graduate nurse places the palm of one hand on the fundus and moves the hand around the abdomen.
- B. The graduate nurse places the heels of both hands on the lower abdomen and presses lightly.
- C. The graduate nurse places one hand on the abdomen over the fundus and with the fingertips, presses gently.
- D. The graduate nurse places the palms of the hands on either side of the abdomen and presses firmly.
Correct Answer: C
Rationale: Strategy: 'MOST appropriate' indicates that this is a priority question. All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) palpations should be done with fingertips, not palms of hands (2) palpations should be done with fingertips, not heels of hands (3) correct-done with fingertips (4) palpations should be done with fingertips, not palms of hands
A 22-year-old woman comes to the hospital at term in the early stages of labor. A diagnosis of complete placenta previa is made.
It would be MOST important for the nurse to take which of the following actions?
- A. Start an IV of terbutaline (Brethine) and monitor the patient's vital signs closely.
- B. Prepare the patient for an immediate cesarean section.
- C. Maintain the patient on bedrest until spontaneous vaginal delivery is achieved.
- D. Monitor the patient's length and duration of contractions.
Correct Answer: B
Rationale: Strategy: Answers are both assessments and implementations. Is the assessment appropriate? No. Determine the outcome of each implementation. Is it desired? (1) implementation, Brethine used to delay delivery in preterm labor (2) correct-implementation, cannot deliver vaginally (3) implementation, cannot deliver vaginally (4) assessment, cannot deliver vaginally, cesarean section must be performed
A woman with chronic obstructive pulmonary disease (COPD) is admitted with an acute exacerbation. Her vital signs are: BP 162/100, pulse 78, respirations 30 and labored with wheezing. The nurse should question which of the following orders?
- A. Theophylline (Somophyllin) 0.7 mg/kg/hr IV.
- B. Tetracycline hydrochloride (Sumycin) 250 mg IM qd.
- C. Ipratropium bromide (Atrovent) inhaler 2 inhalations qid.
- D. Propranolol hydrochloride (Inderal) 40 mg PO bid.
Correct Answer: D
Rationale: Propranolol, a non-selective beta-blocker, can cause bronchoconstriction, worsening COPD. Options A, B, and C are appropriate: theophylline bronchodilates, tetracycline treats infections, and ipratropium reduces bronchospasm.
A woman who recently had a simple mastectomy is about to be discharged. She seems very concerned about such things as where to find the best prosthesis, suitable underwear, and swimsuits, and adjusting to life with only one breast. Which resource is appropriate for the nurse to recommend?
- A. A psychologist or psychiatrist
- B. Reach to Recovery
- C. Pastoral counseling
- D. Her physician
Correct Answer: B
Rationale: Reach to Recovery offers peer support and resources for mastectomy patients, addressing prosthesis and lifestyle adjustments. Other options are less specific.
The nurse is teaching a client with a new diagnosis of hypothyroidism about levothyroxine (Synthroid). Which of the following instructions should the nurse include?
- A. Take the medication at bedtime
- B. Report any chest pain
- C. Stop the medication if symptoms improve
- D. Avoid taking with calcium supplements
Correct Answer: B
Rationale: Chest pain may indicate overstimulation from levothyroxine, mimicking hyperthyroidism. Options A, C, and D are incorrect: morning dosing is preferred, stopping the medication risks relapse, and calcium supplements should be avoided but are secondary.