To prevent drug resistance from developing, the nurse is aware that which of the following is a characteristic of the typical treatment plan to eliminate the tuberculosis bacilli?
- A. An anti-inflammatory agent
- B. High doses of B complex vitamins
- C. Aminoglycoside antibiotics
- D. Administering two anti-tuberculosis drugs
Correct Answer: D
Rationale: Administering two anti-tuberculosis drugs. Resistance of the tubercle bacilli often occurs to a single antimicrobial agent. Therefore, therapy with multiple drugs over a long period of time helps to ensure eradication of the organism.
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The nurse would expect to see which of the following group of symptoms?
- A. Vomiting; extreme thirst; diuresis; coma.
- B. Extreme thirst; cold clammy skin; weakness.
- C. Weight loss; weakness; cold clammy skin; tremors.
- D. Acetone breath smell; lip tremors; weakness.
Correct Answer: A
Rationale: Ketoacidosis presents with vomiting, thirst, diuresis, and risk of coma due to metabolic acidosis.
high serum potassium level.
- A. an increased urinary output.
- B. an elevated hematocrit level.
- C. a fall in central venous pressure.
Correct Answer: B
Rationale: An increased urinary output is a sign of adequate hydration during the second phase of burn recovery.
The nurse is caring for a client with a history of atrial fibrillation who is prescribed warfarin (Coumadin). Which of the following instructions should the nurse include in the client’s teaching?
- A. Eat a consistent amount of green leafy vegetables.
- B. Avoid all physical activity while on this medication.
- C. Take the medication in the morning with breakfast.
- D. Stop the medication if bruising occurs.
Correct Answer: A
Rationale: Warfarin’s effect is influenced by vitamin K in green leafy vegetables, so consistent intake maintains stable INR levels. Activity (B) is encouraged, timing (C) is flexible, and stopping for bruising (D) requires physician consultation.
Which assessment finding would cause the nurse to call the health provider immediately?
- A. The patient becomes more 'wheezy'.
- B. The nurse cannot hear any wheezing in both lungs.
- C. The patient's HR went up to 110 following the administration of albuterol.
- D. The patient coughed up large amount of bronchial secretions.
Correct Answer: B
Rationale: Acute asthma is characterized by expiratory wheezes. Sudden cessation of wheezing is an ominous sign indicating that the small airways are collapsed, requiring immediate intervention.
The nurse is caring for a client with a history of multiple sclerosis. Which of the following interventions should the nurse prioritize?
- A. Encourage high-intensity exercise daily.
- B. Maintain a cool environment.
- C. Administer muscle relaxants as ordered.
- D. Restrict fluid intake to prevent falls.
Correct Answer: B
Rationale: A cool environment prevents symptom exacerbation in multiple sclerosis, as heat worsens neurological symptoms. High-intensity exercise (A) may cause fatigue, muscle relaxants (C) depend on symptoms, and fluid restriction (D) is inappropriate.