Nokea
When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated?
- A. Encouraging the client to speak slowly.
- B. Allowing extra time for the client to respond.
- C. Asking the client to repeat indistinguishable words.
- D. Asking the client to speak louder when tired.
Correct Answer: D
Rationale: Asking the client to speak louder when tired is contraindicated, as it may exacerbate fatigue and worsen speech. Encouraging slow speech, allowing time, and repeating words support communication.
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Which medication is prescribed to prevent uric acid stones?
- A. Hydrochlorothiazide.
- B. Allopurinol.
- C. Potassium citrate.
- D. Acetaminophen.
Correct Answer: B
Rationale: Allopurinol reduces uric acid levels, preventing stone formation.
The nurse is preparing a client for a paracentesis. The nurse should:
- A. Have the client void immediately before the procedure.
- B. Place the client in a side-lying position.
- C. Initiate an I.V. line to administer sedatives.
- D. Place the client on nothing-by-mouth (NPO) status 6 hours before the procedure.
Correct Answer: A
Rationale: Voiding before paracentesis (A) prevents bladder injury during the procedure. Side-lying (B) is incorrect; upright is preferred. IV sedatives (C) are not routine, and NPO status (D) is unnecessary.
The nurse should teach the diabetic client that which of the following is the most common symptom of hypoglycemia?
- A. Nervousness.
- B. Anorexia.
- C. Kussmaul's respirations.
- D. Bradycardia.
Correct Answer: A
Rationale: Nervousness is a common symptom of hypoglycemia due to the body's stress response to low blood glucose levels.
An African-American woman had experienced severe palpitations, weakness, and shortness of breath after taking bacitracin (Bactrim). As a part of the discharge planning, the nurse should evaluate the client's knowledge about:
- A. Increased folic acid needs.
- B. Congenital enzyme deficiency.
- C. Restricted activity in hot weather.
- D. Need for blood transfusions.
Correct Answer: B
Rationale: Bactrim (sulfamethoxazole/trimethoprim) can cause hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, a congenital enzyme deficiency common in African-American populations. The nurse should assess the client's understanding of G6PD deficiency and how to avoid triggers like certain medications. Folic acid, activity restrictions, and transfusions are not directly related.
The nurse should remind the unlicensed personnel that which of the following is the most important goal in the care of the neutropenic client in isolation?
- A. Listening to the client's feelings of concern.
- B. Completing the client's care in a nonhurried manner.
- C. Performing all of the client's care at one time.
- D. Instructing the client to dispose of tissue after blowing the nose.
Correct Answer: C
Rationale: Performing all care at one time minimizes disruptions and reduces the risk of introducing pathogens to a neutropenic client in isolation. Emotional support, nonhurried care, and tissue disposal are important but secondary to infection prevention.