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The nurse notices drops of a liquid on the hallway floor of a health care facility. The nurse should do which of the following first?
- A. Place paper towels over the drops of liquid.
- B. Don clean gloves and wipe up the drops of liquid.
- C. Post 'wet floor' signs around the area.
- D. Call the Environmental Services Department.
Correct Answer: C
Rationale: Posting 'wet floor' signs first ensures immediate safety by alerting others to the hazard, preventing slips. Then, the nurse can proceed with cleanup or notify appropriate personnel.
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Allopurinol (Zyloprim) is prescribed for a client who has chronic gout. Which of the following comments indicates that the client understands how to take the allopurinol?
- A. I will take the medication whenever my joints hurt.'
- B. I must take this drug on an empty stomach.'
- C. I should drink plenty of fluids when taking allopurinol.'
- D. I should not take aspirin when taking allopurinol.'
Correct Answer: C
Rationale: Drinking plenty of fluids prevents uric acid crystal formation, enhancing allopurinol's effectiveness in managing gout.
Communicating with parents and children about health care has become increasingly significant because:
- A. Consumers of health care cannot keep up with rapid advances in science.
- B. The influence of the media and specialization have increased the complexity of managing health.
- C. Nurse educators have recognized the value of communication.
- D. Clients are more demanding that their rights be respected.
Correct Answer: B
Rationale: Media influence and medical specialization have increased healthcare complexity, making clear communication essential to ensure understanding and informed decision-making.
A client with a history of depression is prescribed bupropion (Wellbutrin). The nurse should instruct the client to report which of the following side effects immediately?
- A. Mild headache.
- B. Seizures.
- C. Nausea.
- D. Fatigue.
Correct Answer: B
Rationale: Bupropion lowers the seizure threshold, and seizures are a serious side effect requiring immediate reporting.
A client has received an overdose of sympathomimetic agents. The nurse should assess the client for which of the following late signs of an overdose? Select all that apply.
- A. Hypotension.
- B. Bradycardia.
- C. Seizures.
- D. Profound pyrexia.
- E. Hypertension.
Correct Answer: C, D, E
Rationale: Sympathomimetic overdose can cause seizures, profound pyrexia (fever), and hypertension due to excessive stimulation of the sympathetic nervous system.
Your client has been getting total parenteral nutrition for bowel rest for the last four days. During your assessment of the client today, your client tells you that their 'chest hurts'. You assess that the client is also experiencing dyspnea. What is most likely occurring with this client?
- A. Your client may be experiencing a fluid overload.
- B. Your client may be experiencing an embolus.
- C. Your client may be hyperglycemic.
- D. Your client may have an inadvertent pneumothorax.
Correct Answer: B
Rationale: Chest pain and dyspnea in a client receiving TPN suggest a possible embolus, such as a pulmonary embolism, which is a serious complication requiring immediate attention.