Nokea
The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects?
- A. Increases the risk of vaginal infection.
- B. Has mutagenic effects on ova.
- C. Decreases the effectiveness of hormonal contraceptives.
- D. Inhibits ovulation.
Correct Answer: C
Rationale: Isoniazid induces liver enzymes, potentially reducing the effectiveness of hormonal contraceptives. It does not increase vaginal infection risk, affect ova, or inhibit ovulation.
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A 72-year-old client with cancer needs assistance with paying hospital bills. The nurse should refer the client to a:
- A. Bank representative.
- B. Social worker.
- C. Loan officer.
- D. Representative of the hospital billing department.
Correct Answer: B
Rationale: A social worker can connect the client with financial assistance programs and resources to help manage hospital bills.
When the nurse is conducting a preoperative interview with a client who is having a vaginal hysterectomy, the client states that she forgot to tell her doctor that she had a total hip replacement 3 years ago. The nurse communicates this information to the perioperative nurse because:
- A. The prosthesis may cause a problem with the electrosurgical unit used to control bleeding.
- B. The client should not have her hip externally rotated when she is positioned for the procedure.
- C. The perioperative nurse can inform the rest of the team about the total hip replacement.
- D. There is not enough time to notify the surgeon and note this finding on the history and physical information before the procedure.
Correct Answer: A
Rationale: A hip prosthesis can conduct electricity from an electrosurgical unit, risking burns or complications. Communicating this ensures precautions are taken during surgery.
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to:
- A. Irrigate the catheter with 30 mL of normal saline every 8 hours.
- B. Ensure that the catheter is draining freely.
- C. Clamp the catheter every 2 hours for 30 minutes.
- D. Ensure that the catheter drains at least 30 mL/hour.
Correct Answer: B
Rationale: Ensuring free drainage prevents obstruction or pressure buildup, which could harm the surgical site or kidney function.
A nurse is developing a care plan for a client with hepatic encephalopathy. Which of the following are goals for the care for this client? Select all that apply.
- A. Preventing constipation.
- B. Administering lactulose (Cephulac).
- C. Monitoring coordination while walking.
- D. Checking the pupil reaction.
- E. Increasing food and fluids high in carbohydrate.
- F. Encouraging physical activity.
Correct Answer: A,B
Rationale: Preventing constipation (A) and administering lactulose (B) reduce ammonia levels, key in managing hepatic encephalopathy. Coordination (C) and pupil reaction (D) are unrelated. High carbohydrates (E) and physical activity (F) are not primary goals.
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
- A. Cancer.
- B. Hypertension.
- C. Liver disease.
- D. Myocardial damage.
Correct Answer: D
Rationale: Elevated myoglobin indicates myocardial damage, as it is released from injured cardiac muscle, supporting a diagnosis of MI.