Nokea
The physician orders furosemide (Lasix) 40 mg IV STAT for an acutely fluid-overloaded patient. Why was the IV route likely chosen?
- A. Furosemide can be administered only by the IV route.
- B. IV is the route of choice for rapid administration.
- C. IV dosing is more accurate.
- D. IV furosemide has a fewer side effects than oral.
Correct Answer: B
Rationale: The IV route was likely chosen for the administration of furosemide (Lasix) in this acutely fluid-overloaded patient because IV is the route of choice when rapid administration is needed. When given intravenously, the medication is able to produce a quicker and more immediate diuretic effect compared to oral administration, allowing for more rapid relief of fluid overload symptoms. This can be crucial in emergency situations where the patient's condition requires fast intervention.
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Which of the following medications should then nurse explain may cause headache as a side effect?
- A. Furosemide (Lasix)
- B. Clonidine (Catapres)
- C. Atenolol ((Tenormin)
- D. Adalat (Procardia)
Correct Answer: D
Rationale: Adalat (Procardia) belongs to a class of medications known as calcium channel blockers. Headache is a common side effect associated with the use of calcium channel blockers, including Adalat (Procardia). The mechanism behind this side effect is related to the vasodilatory effects of calcium channel blockers, which can lead to relaxation and widening of blood vessels, potentially causing headaches. It is important for the nurse to explain to the patient that headache is a possible side effect of Adalat (Procardia) and to consult the healthcare provider if it becomes bothersome or severe.
The nurse is examining an infant for hip placement and has abducted her flexed legs. The nurse should next:
- A. Rotate the hips.
- B. Extend the legs.
- C. Listen for a "click."
- D. Palpate the hips for a mass.
Correct Answer: C
Rationale: In this scenario, the nurse is performing Ortolani's maneuver, which is used to assess for developmental dysplasia of the hip (DDH) in infants. After abducting the infant's flexed legs, the nurse should then listen for a "click" that may indicate hip instability. A positive click suggests subluxation of the femoral head and may indicate the presence of DDH. It is important for the nurse to recognize this finding promptly and report it to the healthcare provider for further evaluation and management. Rotation of the hips, extending the legs, and palpating for a mass are not the appropriate next steps in this specific assessment for DDH.
Mrs. Zeno asks the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
- A. A genetic defect in the production of acetylcholine
- B. A reduced amount of neurotransmitter acetylcholine
- C. A decreased number of functioning acetyl-choline receptor sites
- D. An inhibition of the enzyme Ache leaving the end plates folded.
Correct Answer: C
Rationale: The disease mentioned in the question is likely myasthenia gravis. Myasthenia gravis is an autoimmune disorder where the body's immune system attacks acetylcholine receptors at the neuromuscular junction. Acetylcholine is a neurotransmitter responsible for transmitting nerve impulses to muscles. In myasthenia gravis, the immune system destroys or blocks the acetylcholine receptor sites on muscle cells, leading to a decrease in the number of functioning receptor sites. This results in muscle weakness and fatigue because the communication between nerves and muscles is impaired. This is why the nurse would base the reply on the knowledge that there is a decreased number of functioning acetyl-choline receptor sites as the underlying cause of the disease.
Chemotherapy has a major role in many childhood CNS tumors. In which of the following tumors is chemotherapy not effective?
- A. pilocytic astrocytoma
- B. craniopharyngioma
- C. pineoblastoma
- D. supratentorial primitive neuroectodermal tumors (SPNETs)
Correct Answer: A
Rationale: Pilocytic astrocytomas are generally low-grade and less responsive to chemotherapy compared to other listed tumors.
A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:
- A. Helping the client cope with body image
- B. Maintaining a patent airway.
- C. Preventing injury.
- D. Ensuring adequate nutrition.
Correct Answer: B
Rationale: In a client with esophageal cancer who is experiencing difficulty swallowing, maintaining a patent airway is the highest priority. The client is at risk for aspiration due to the compromised ability to swallow, which could lead to respiratory distress, choking, or aspiration pneumonia. Adequate oxygenation is essential for the client's survival and must be addressed as the priority issue. While coping with body image, preventing injury, and ensuring nutrition are important aspects of care, they are secondary to ensuring the client's airway remains open and clear to prevent respiratory complications.