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What are the nursing interventions for a patient with hypokalemia?
- A. Administer potassium supplements and monitor ECG
- B. Provide a high-sodium diet and monitor for hypertension
- C. Monitor for muscle weakness and provide dietary education
- D. Administer diuretics and provide oral fluids
Correct Answer: A
Rationale: The correct intervention for a patient with hypokalemia is to administer potassium supplements and monitor the ECG. Potassium supplements help correct the low potassium levels in the body, while ECG monitoring is essential to detect any cardiac arrhythmias associated with hypokalemia. Choice B is incorrect because a high-sodium diet would worsen hypokalemia by further depleting potassium levels. Choice C is incorrect as it only focuses on monitoring symptoms and providing dietary education, but does not address the immediate need to correct potassium levels. Choice D is also incorrect as administering diuretics would exacerbate hypokalemia by increasing potassium loss.
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A nurse is preparing to administer insulin to a client who has type 1 diabetes mellitus. After drawing up the medication, the nurse accidentally brushes the needle on the counter's surface. Which of the following actions should the nurse take?
- A. Prepare a new dose of insulin injection
- B. Administer the insulin as it is
- C. Wipe the needle with an alcohol swab
- D. Ask the provider for guidance
Correct Answer: A
Rationale: The correct action for the nurse to take is to prepare a new dose of insulin injection. Accidentally brushing the needle on a contaminated surface can lead to infection risk. Administering the insulin as it is or just wiping the needle with an alcohol swab would not be sufficient to eliminate the risk of infection. Asking the provider for guidance is not necessary in this situation as the nurse can independently take the appropriate action to ensure patient safety.
What is the study of conduct and character?
- A. Ethics
- B. Justice
- C. Morals
- D. Non-maleficence
Correct Answer: A
Rationale: Ethics is the correct answer because it specifically deals with the study of conduct and character. Ethics is a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. While justice and morals are related to ethical considerations, they do not directly represent the study of conduct and character. Non-maleficence is a principle in medical ethics related to avoiding harm.
A nurse is reviewing the plan of care for a client who is postoperative following a hip replacement. Which of the following interventions should the nurse implement to prevent venous thromboembolism?
- A. Instruct the client to perform ankle pumps
- B. Administer anticoagulant therapy as prescribed
- C. Maintain the client in a prone position
- D. Encourage the client to ambulate as tolerated
Correct Answer: B
Rationale: The correct intervention to prevent venous thromboembolism in a postoperative client following hip replacement is to administer anticoagulant therapy as prescribed. Anticoagulants help prevent blood clots from forming. Instructing the client to perform ankle pumps helps prevent blood clots by promoting circulation. Maintaining the client in a prone position can increase the risk of venous stasis and thrombus formation. Encouraging the client to ambulate as tolerated also helps prevent venous thromboembolism by promoting blood flow and preventing stasis.
A client at 30 weeks of gestation reports constipation. Which of the following recommendations should the nurse make?
- A. Drink 1 liter of water per day.
- B. Take a laxative every morning.
- C. Increase your intake of refined grains.
- D. Walk for at least 30 minutes every day.
Correct Answer: D
Rationale: The correct recommendation is to walk for at least 30 minutes every day. Walking stimulates intestinal motility, which can help relieve constipation during pregnancy. Option A is important for overall hydration but may not directly address constipation. Option B is not recommended without healthcare provider approval as some laxatives are contraindicated in pregnancy. Option C, increasing intake of refined grains, may exacerbate constipation due to lower fiber content.
The nurse is making a home visit with a client diagnosed with Alzheimer's disease. The client recently started on lorazepam (Ativan) due to increased anxiety. The nurse is cautioning the family about the use of lorazepam (Ativan). The nurse should instruct the family to report which of the following significant side effects to the healthcare provider?
- A. Paradoxical excitement
- B. Headache
- C. Slowing of reflexes
- D. Fatigue
Correct Answer: A
Rationale: The correct answer is A, paradoxical excitement. Lorazepam can cause an unexpected response of paradoxical excitement, which should be reported to the healthcare provider. This reaction is characterized by increased anxiety, restlessness, and agitation instead of the expected calming effect. Choices B, C, and D are incorrect because headache, slowing of reflexes, and fatigue are more common side effects of lorazepam and may not warrant immediate reporting unless severe or persistent.