Nokea
The physician has ordered amitriptyline (Elavil) for a client with depression. The nurse should tell the client that:
- A. The medication will produce a rapid improvement in mood
- B. He might experience difficulty with urination
- C. He should avoid milk products while taking the medication
- D. The medication should be discontinued if he experiences dry mouth
Correct Answer: B
Rationale: Difficulty with urination is a common amitriptyline side effect (anticholinergic), needing monitoring mood improvement takes weeks, milk isn't restricted, and dry mouth doesn't warrant stopping. Nurses teach this, managing expectations, ensuring adherence in depression treatment.
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When a client wishes to improve the appearance of their eyes by removing excess skin from the face and neck, the nurse should provide teaching regarding which of the following procedures?
- A. Dermabrasion
- B. Rhinoplasty
- C. Blepharoplasty
- D. Rhytidectomy
Correct Answer: D
Rationale: Rhytidectomy (facelift) removes excess skin from face and neck.
Becky has been NPO since midnight in preparation for a blood test. The adreno-cortical response is activated. Which of the following is an expected response?
- A. Low blood pressure
- B. Warm, dry skin
- C. Decreased serum sodium levels
- D. Decreased urine output
Correct Answer: D
Rationale: The adrenocortical response, triggered by fasting (NPO status), activates stress hormones like cortisol and aldosterone, conserving resources during deprivation. Decreased urine output results from aldosterone's promotion of sodium and water reabsorption in the kidneys, maintaining fluid volume and blood pressure. This adaptation counters the stress of fasting, ensuring homeostasis. Low blood pressure would oppose this, as the response aims to stabilize circulation, not reduce it. Warm, dry skin isn't typical; stress might cause cool, clammy skin from vasoconstriction, but fasting alone doesn't dictate this. Decreased serum sodium levels contradict aldosterone's sodium-retaining effect, which elevates or stabilizes sodium. Decreased urine output aligns with the body's conservation mechanism, making it the expected physiological response in this scenario, critical for nurses to recognize during patient monitoring.
When working as a licensed vocational nurse, you determine that your client scheduled for surgery does not understand the physician's earlier explanation of the surgery. The client is asking many questions about the risks and seems worried. Which of the following actions would be best on your part?
- A. Quickly explain the surgery procedures and the risks to the client.
- B. Cancel the surgery.
- C. Ask your supervising RN to explain the surgery procedure and its risks.
- D. Notify the physician.
Correct Answer: D
Rationale: When a client scheduled for surgery shows a lack of understanding and expresses concern, notifying the physician is the best action for a licensed vocational nurse. The physician, as the primary decision-maker and the one obtaining informed consent, has the responsibility to ensure the client fully comprehends the procedure, risks, and benefits. The nurse's role is to facilitate communication and advocate for the client's needs, not to independently explain complex medical details outside their scope or cancel the surgery, which exceeds their authority. Asking the supervising RN might help, but it delays direct resolution by the physician, who is legally accountable for ensuring consent is informed. This approach upholds the nurse's duty to prioritize client understanding and safety while respecting professional boundaries and legal standards.
The nurse questions a doctors order of Morphine sulfate 50 mg, IM for a client with pancreatitis. Which role best fit that statement?
- A. Change agent
- B. Client advocate
- C. Case manager
- D. Collaborator
Correct Answer: B
Rationale: Questioning a morphine order for pancreatitis exemplifies the client advocate role, where nurses safeguard patient well-being. Morphine can worsen pancreatitis by causing sphincter of Oddi spasm, unlike safer options like meperidine. By challenging this, the nurse protects the client from harm, a duty rooted in ethical codes like the ANA's. Change agents modify behaviors, case managers coordinate, and collaborators work jointly, but advocacy uniquely prioritizes patient safety over compliance. In practice, this might involve consulting the doctor for an alternative, ensuring care aligns with the patient's best interest, a critical nursing responsibility.
Which of the following statement best describe autonomy?
- A. Doing good for the client
- B. Fairness and equality
- C. Respecting client's decision
- D. Keeping promises
Correct Answer: C
Rationale: Autonomy is respecting client decisions (C), per ethics self-determination (e.g., refusing care). Doing good (A) is beneficence, fairness (B) justice, promises (D) fidelity. C best defines autonomy's focus, making it correct.