Nokea
The nurse is teaching a client with a new diagnosis of rheumatoid arthritis about hydroxychloroquine (Plaquenil). Which of the following statements by the client indicates a need for further teaching?
- A. I should report vision changes to my doctor.
- B. I should take this medication with food.
- C. I should have regular eye exams.
- D. I should stop this medication if my joints feel better.
Correct Answer: D
Rationale: Stopping hydroxychloroquine when joints feel better is incorrect, as rheumatoid arthritis requires ongoing treatment to prevent flares. Options A, B, and C are correct: vision changes may indicate retinal toxicity, food reduces GI upset, and eye exams monitor for toxicity.
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An adult is receiving lithium carbonate 600 mg tid. Which of the following observations is of greatest concern to the nurse?
- A. The serum lithium level is 1.0 mEq/L.
- B. The client states that she is going to go on a low-sodium diet.
- C. The client has gaining 10 lb in the last three months.
- D. The client says, 'I always drink a lot of water when I take the pills.'
Correct Answer: B
Rationale: A low-sodium diet increases lithium retention, risking toxicity, a serious concern requiring immediate education or intervention.
The nurse has just received report on a group of clients and plans to delegate care of several of the clients to a practical nurse (PN). The first thing the RN should do before the delegation of care is
- A. Provide a time-frame for the completion of the client care
- B. Assure the PN that the RN will be available for assistance
- C. Ask about prior experience with similar clients
- D. Review the specific procedures unique to the assignment
Correct Answer: C
Rationale: The first step in delegation is to determine the qualifications of the person to whom one is delegating. By asking about the PN’s prior experience with similar clients/tasks, the RN can determine whether the PN has the requisite experience to care for the assigned clients.
Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parents remark: 'We just don't know how he caught the disease!' The nurse's response is based on an understanding that
- A. AGN is a streptococcal infection that involves the kidney tubules
- B. The disease is easily transmissible in schools and camps
- C. The illness is usually associated with chronic respiratory infections
- D. It is not 'caught' but is a response to a previous B-hemolytic strep infection
Correct Answer: D
Rationale: It is not 'caught' but is a response to a previous B-hemolytic strep infection. AGN is generally accepted as an immune-complex disease in relation to an antecedent streptococcal infection of 4 to 6 weeks prior.
Which of the following symptoms is not indicative of autonomic dysreflexia in the client with a spinal cord injury?
- A. sudden onset of headache
- B. flushed face
- C. hypotension
- D. nasal congestion
Correct Answer: C
Rationale: Hypotension is not indicative of autonomic dysreflexia; rather, hypertension is a sign of autonomic dysreflexia.
A 19-year-old woman after delivery of a 7 lb 10 oz baby boy. The patient has decided to bottle-feed her infant.
The nurse should encourage the patient to
- A. use the manual breast pump to relieve breast engorgement.
- B. apply warm packs to the breast to relieve discomfort.
- C. massage the breasts to reduce engorgement and discomfort.
- D. wear a well supportive bra and take Tylenol for discomfort.
Correct Answer: D
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) will encourage milk secretion (2) will enhance flow of milk (3) may be taut due to engorgement, massage would be painful and unnecessary, will encourage milk flow (4) correct-will help minimize discomfort during period of engorgement