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The patient is prescribed metronidazole (Flagyl) for adjunct treatment for a duodenal ulcer. When teaching about this medication, the nurse would include:
- A. This medication should be taken only until you begin to feel better.'
- B. This medication should be taken on an empty stomach to increase absorption.'
- C. While taking this medication, you do not have to be concerned about being in the sun.'
- D. While taking this medication, alcoholic beverages and products containing alcohol should be avoided.'
Correct Answer: D
Rationale: Metronidazole can cause a disulfiram-like reaction with alcohol, so avoidance is critical.
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The nurse is caring for a client hospitalized with a facial stroke. Which diet selection would be suited to the client?
- A. Roast beef sandwich, potato chips, pickle spear, iced tea
- B. Split pea soup, mashed potatoes, pudding, milk
- C. Tomato soup, cheese toast, Jello, coffee
- D. Hamburger, baked beans, fruit cup, iced tea
Correct Answer: B
Rationale: Soft foods like split pea soup, mashed potatoes, and pudding are easier to swallow for a client with a facial stroke, reducing the risk of aspiration.
The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates the client understands his new diet?
- A. Cornflakes, whole milk, banana, and coffee
- B. Scrambled eggs, bacon, toast, and coffee
- C. Oatmeal, apple juice, dry toast, and coffee
- D. Pancakes, ham, tomato juice, and coffee
Correct Answer: C
Rationale: Oatmeal, apple juice, and dry toast are low in sodium and saturated fat, aligning with a DASH diet for hypertension management.
The nurse is preparing to administer a dose of enoxaparin (Lovenox) to a client with a pulmonary embolism. Which of the following actions by the nurse is correct?
- A. Administer the injection in the deltoid muscle.
- B. Massage the injection site after administration.
- C. Inject the medication into the abdomen, at least 2 inches from the umbilicus.
- D. Aspirate before injecting to check for blood return.
Correct Answer: C
Rationale: enoxaparin is administered subcutaneously in the abdomen, at least 2 inches from the umbilicus, without aspiration or massage
A client is admitted to the emergency room with multiple injuries. What is the proper sequence for managing the client?
- A. Assess for head injuries, control hemorrhage, establish an airway, prevent hypovolemic shock
- B. Control hemorrhage, prevent hypovolemic shock, establish an airway, assess for head injuries
- C. Establish an airway, control hemorrhage, prevent hypovolemic shock, assess for head injuries
- D. Prevent hypovolemic shock, assess for head injuries, establish an airway, control hemorrhage
Correct Answer: C
Rationale: The ABCs of trauma care prioritize airway, breathing, and circulation. Establishing an airway comes first, followed by controlling hemorrhage and preventing shock, then assessing for head injuries.
A student nurse is precepting on the unit and caring for a client with a Dobbhoff nasoenteric tube. Which statement by the student nurse indicates the need for further teaching on caring for a client with this tube? Select all that apply.
- A. I should wait for X-ray confirmation before using the tube.
- B. I can confirm placement by auscultating over the epigastric area.
- C. I can mix liquid medications in with the tube feeding for administration.
- D. I will flush the tube with 20 to 30 mL of water every 4 hours during continuous tube feeding.
- E. I will observe the client for diarrhea, abdominal distention, nausea and vomiting, and tube dislodgement.
Correct Answer: B, C
Rationale: Auscultation is not a reliable method for confirming tube placement; X-ray is required. Mixing medications with feedings can cause clogs or interactions. The other statements are correct.