Nokea
The physician has ordered a serum aminophylline level for a client with chronic obstructive lung disease. The nurse knows that the therapeutic range for aminophylline is:
- A. 1-3 micrograms/mL
- B. 4-6 micrograms/mL
- C. 7-9 micrograms/mL
- D. 10-20 micrograms/mL
Correct Answer: D
Rationale: The therapeutic range for aminophylline is 10-20 micrograms/mL to effectively manage symptoms of chronic obstructive lung disease.
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A client who experienced a cardiac arrest and resuscitation is exhibiting characteristics of mild anoxic brain injury. Which of the following characteristics does the nurse expect her to exhibit? Select all that apply.
- A. Decreased ability to concentrate.
- B. Seizures.
- C. Memory impairment.
- D. Semicomatose state.
- E. Decreased balance.
- F. Restlessness.
Correct Answer: A,C,E,F
Rationale: Mild anoxic brain injury may cause decreased concentration (A), memory impairment (C), decreased balance (E), and restlessness (F). Seizures (B) and semicomatose state (D) are more typical of severe injury.
A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client's need for:
- A. Supplemental oxygen
- B. Fluid restriction
- C. Blood transfusion
- D. Delivery by Caesarean section
Correct Answer: A
Rationale: Sickle cell anemia increases oxygen demand during labor, often requiring supplemental oxygen.
Which client is at greatest risk for complications following abdominal surgery?
- A. A 68-year-old obese client with noninsulin-dependent diabetes
- B. A 27-year-old client with a recent history of urinary tract infections
- C. A 16-year-old client who smokes a half-pack of cigarettes per day
- D. A 40-year-old client who exercises regularly, with no history of medical conditions
Correct Answer: A
Rationale: Obesity and diabetes increase the risk of surgical complications like infection and poor wound healing.
The nurse is caring for a client with bipolar disorder. The client has been manipulating some of the staff and other clients in order to get her way. Which actions by the nurse are appropriate in managing this client? Select all that apply.
- A. giving support when the client exhibits positive behaviors
- B. setting clear limits and communicating expected behaviors
- C. role playing with the client to demonstrate appropriate behaviors
- D. treating the client more like a friend in order to show respect for her as a person
- E. giving the client small gifts, such as extra dessert, in order to encourage appropriate behavior
Correct Answer: A,B,C
Rationale: Appropriate actions include reinforcing positive behaviors (A), setting clear limits (B), and role-playing (C) to promote appropriate interactions. Treating as a friend (D) or giving gifts (E) blurs boundaries and encourages manipulation.
The nurse is caring for a client 7 days post-burn injury with 60% body surface area involved. The nursing care of this client would primarily focus on:
- A. Meticulous infection-control measures
- B. Fluid-replacement evaluation
- C. Psychological adjustment to the wound
- D. Measurement and application of a pressure garment
Correct Answer: A
Rationale: At 7 days post-burn, infection is a major risk due to open wounds and immunosuppression, making meticulous infection control the primary focus.