Nokea
The nurse is teaching a client with chronic kidney disease about sevelamer (Renagel). Which of the following instructions should the nurse include?
- A. Take the medication with meals.
- B. Stop the medication if phosphate levels are normal.
- C. Avoid reporting constipation.
- D. Take the medication with calcium supplements.
Correct Answer: A
Rationale: Sevelamer binds phosphate during meals, reducing absorption. Options B, C, and D are incorrect.
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The nurse is preparing to begin a dopamine (Intropin) infusion on a client.
Before beginning the infusion the nurse should
- A. evaluate the urine output.
- B. obtain the client's weight.
- C. determine the patency of the IV line.
- D. measure pulmonary artery pressures.
Correct Answer: C
Rationale: Strategy: Determine how each answer choice relates to dopamine. (1) not a critical assessment at this time (2) contains correct information, but is not a priority (3) correct-if extravasation occurs, there is sloughing of the surrounding skin and tissue; patent IV line is essential to prevent serious side effects (4) not a critical assessment at this time
The nurse is teaching a client about warfarin (Coumadin) therapy. Which of the following statements by the client indicates a need for further teaching?
- A. I will avoid contact sports while taking this medication.
- B. I will check with my doctor before taking any new medications.
- C. I will increase my intake of green leafy vegetables.
- D. I will report any unusual bleeding to my doctor.
Correct Answer: C
Rationale: green leafy vegetables are high in vitamin K, which can decrease the effectiveness of warfarin
The nurse teaches a group of boy scouts how to prevent Lyme disease. Which of the following statements, if made by one of the boy scouts to the nurse, would indicate that further teaching is necessary?
- A. When I go on a long hike, I should check any exposed skin for insects every four hours.
- B. When I hike in the woods, I should wear long pants, socks, and a long-sleeved shirt.
- C. I should remove any ticks by crushing them firmly against the skin.
- D. I should reapply insect repellant every couple of hours when hiking.
Correct Answer: C
Rationale: should not be crushed, remove tick with tweezers or fingers and flush down toilet; burning a tick could spread infection
An intravenous pyelogram (IVP) is ordered for a client who is scheduled to have his left kidney removed because of hypertension and renal disease. Which of the following nursing actions has the highest priority the evening prior to the IVP?
- A. Administer a cathartic enema to cleanse the bowel.
- B. Obtain information about client allergies.
- C. Instruct the client to be NPO after midnight.
- D. Teach the client that x-rays will be taken at multiple intervals.
Correct Answer: B
Rationale: assessment, clients sensitive to iodine can develop anaphylaxis; client should be asked specifically about allergies to iodine; iodine is present in the radiopaque material that is injected IV
An elderly client receiving IV fluids of 0.9% NaCl at 125 cc/h into her left arm. During a routine assessment, the nurse finds that the client has distended neck veins, shortness of breath, and crackles in both lung bases.
The nurse should
- A. decrease the IV rate to 20 cc/h and notify the physician.
- B. decrease the IV rate to 100 cc/h and continue to monitor the client.
- C. discontinue the IV and start oxygen at 6 L/min.
- D. assess for infiltration of the IV solution.
Correct Answer: A
Rationale: Strategy: Answers are a mix of assessments and implementations. Is the assessment appropriate? No. Determine the outcome of each implementation. (1) correct-KVO (20 cc/h) will keep access open (2) need to notify physician, rate still too much since patient is in fluid overload (3) IV line may be necessary, diuretics may be ordered (4) description indicates circulatory overload, not infiltration