Nokea
What nursing intervention can help alleviate pruritus in a client with cirrhosis?
- A. Administering antihistamines
- B. Providing a high-protein diet
- C. Applying emollients to the skin
- D. Encouraging frequent baths with hot water
Correct Answer: C
Rationale: The correct answer is C: Applying emollients to the skin. Pruritus is common in cirrhosis due to bile salt accumulation. Emollients help hydrate and protect the skin, reducing itching. Antihistamines (A) may not be effective for pruritus in cirrhosis. High-protein diet (B) is unrelated to pruritus. Hot water baths (D) can worsen itching by drying out the skin.
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A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?
- A. I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.
- B. It's hard to believe that there are actually medications that can treat obesity.
- C. I'm a bit nervous to start this medication because I know I'll need blood tests sometimes.
- D. I'm going to have to do some rearranging of my finances to make sure I can afford this medication.
Correct Answer: A
Rationale: The correct answer is A because the client's statement indicates a lack of understanding about the comprehensive approach needed to address obesity. Phentermine/topiramate-ER is not a standalone solution; it is most effective when used in conjunction with lifestyle changes like exercise and dietary modifications. By expressing a dislike for exercise and dietary changes, the client demonstrates a reliance solely on the medication, which is not conducive to long-term weight management. This suggests a need for further education on the importance of holistic lifestyle modifications in conjunction with medication therapy.
Choice B is incorrect because the client expressing disbelief at medications for obesity is not necessarily indicative of a need for further education; it may simply reflect surprise or lack of awareness. Choice C is incorrect as the client's nervousness about blood tests is a common concern and does not necessarily indicate a need for more education. Choice D is also incorrect as financial concerns are valid but do not directly relate to the need for additional health education.
A client admitted with a diagnosis of sepsis has a central venous pressure (CVP) of 15 mm Hg. What should the nurse do first?
- A. Administer a fluid bolus of 500 ml.
- B. Notify the healthcare provider immediately.
- C. Administer a diuretic.
- D. Continue to monitor the CVP.
Correct Answer: B
Rationale: The correct answer is B: Notify the healthcare provider immediately. A CVP of 15 mm Hg in a client with sepsis may indicate fluid overload or cardiac dysfunction, which require prompt medical intervention. Notifying the healthcare provider allows for timely assessment and appropriate management. Administering a fluid bolus (A) without further evaluation can exacerbate fluid overload. Administering a diuretic (C) without knowing the underlying cause can be harmful. Continuing to monitor the CVP (D) is important, but immediate action is required due to the high CVP level.
A 48-year-old man presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: A
Rationale: The correct answer is A: Hypothyroidism. In this scenario, the patient has symptoms of hypothyroidism (fatigue, weight gain, cold intolerance) along with high TSH and low free T4 levels, indicating primary hypothyroidism. TSH is elevated as the body is trying to stimulate the thyroid to produce more thyroid hormones. Free T4 is low as the thyroid is not able to produce enough hormones. Hyperthyroidism (choice B) would present with low TSH and high free T4 levels. Thyroiditis (choice C) typically presents with symptoms of hyperthyroidism followed by hypothyroidism. Thyroid cancer (choice D) usually does not cause these specific symptoms and lab findings. Therefore, based on the symptoms and lab results, hypothyroidism is the most likely diagnosis.
Your patient has an order to receive Levothyroxine Sodium 75 mcg daily IV. You have a vial containing 100 mcg available from the pharmacy. According to the package insert, 5 mL of 0.9% sodium chloride is needed to reconstitute. You add the appropriate amount of sodium chloride to the vial. How many mcg of medication are in 1 mL of the vial?
- A. 20 mcg
- B. 15 mcg
- C. 25 mcg
- D. 30 mcg
Correct Answer: A
Rationale: The correct answer is A: 20 mcg. To determine the amount of medication in 1 mL of the vial, you first need to reconstitute the vial with 5 mL of sodium chloride. This will result in a total of 100 mcg of Levothyroxine Sodium in the vial. To find out how much medication is in 1 mL, you divide the total amount by the volume of the vial (100 mcg / 5 mL = 20 mcg/mL). Therefore, there are 20 mcg of medication in 1 mL of the vial.
Choice B, C, and D are incorrect because they do not accurately calculate the amount of medication in 1 mL of the vial based on the given information and the reconstitution process.
A client with hepatic encephalopathy is being treated with lactulose. What is an expected outcome of this treatment?
- A. Reduction in blood ammonia levels
- B. Improvement in liver enzyme levels
- C. Decrease in bilirubin levels
- D. Increase in urine output
Correct Answer: A
Rationale: Step-by-step rationale:
1. Lactulose works by reducing blood ammonia levels through promoting its excretion in the stool.
2. Hepatic encephalopathy is caused by elevated blood ammonia levels affecting brain function.
3. Therefore, the expected outcome of lactulose treatment is a reduction in blood ammonia levels, improving the client's condition.
Summary:
- Reduction in blood ammonia levels is the correct outcome as lactulose targets this mechanism.
- Improvement in liver enzyme levels and decrease in bilirubin levels are not direct effects of lactulose.
- Increase in urine output is not a typical outcome of lactulose treatment for hepatic encephalopathy.