Nokea
The nurse preparing a site for the insertion of an IV catheter should treat excess hair at the site by:
- A. Leaving the hair intact
- B. Shaving the area
- C. Clipping the hair in the area
- D. Removing the hair with a depilatory
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A female patient is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and her heart 'flutters' frequently. What action should the nurse take?
- A. Tell the patient to rest more often.
- B. Tell the patient to stop taking the digoxin, and call the physician.
- C. Call the physician, report the symptoms, and request to draw a blood sample to determine the patient's potassium level.
- D. Tell the patient to avoid foods that contain caffeine.
Correct Answer: C
Rationale: Furosemide is a potassium-wasting diuretic. A low potassium level may cause weakness and palpitations. Telling the patient to rest more often won't help the patient if she's hypokalemic. Digoxin isn't causing the patient's symptoms, so she doesn't need to stop taking it. The patient should probably avoid caffeine, but this wouldn't resolve potassium depletion.
The nurse working in the PACU is aware that which of the following procedures may contribute to extracellular losses?
- A. Removal of an ingrown toenail
- B. Tooth extraction
- C. Abdominal surgery
- D. Cataract surgery
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which of the following might the nurse assess in a patient diagnosed with hypermagnesemia?
- A. Diminished deep tendon reflexes
- B. Tachycardia
- C. Cool clammy skin
- D. Increased serum magnesium
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A nurse preparing to start an IV on a newly admitted patient teaches the patient about the procedure and begins to prepare the site. The nurse should always start by:
- A. Leaving one hand ungloved to assess the site
- B. Preparing the skin with an iodine solution
- C. Asking the patient if he is allergic to latex or iodine
- D. Removing excessive hair at the selected site
Correct Answer: C
Rationale: Before preparing the skin, the nurse should ask the patient if he or she is allergic to latex or iodine, which are products commonly used in setting up for IV therapy. A local reaction could result in irritation to the IV site or, in the extreme, it could result in anaphylaxis, which can be life threatening.
The nurse is caring for a patient who is diaphoretic from a fever. The amount of sodium excreted in the urine will:
- A. Decrease
- B. Increase
- C. Remain unchanged
- D. Fluctuate
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.