Nokea
Which electrolyte imbalance is commonly associated with patients on furosemide?
- A. Hypokalemia
- B. Hyponatremia
- C. Hyperkalemia
- D. Hypercalcemia
Correct Answer: A
Rationale: The correct answer is A: Hypokalemia. Furosemide, a loop diuretic, can lead to potassium loss in the body, resulting in hypokalemia. This electrolyte imbalance is commonly associated with furosemide use due to its mechanism of action in the kidneys. Hyponatremia (choice B) is not typically associated with furosemide. Hyperkalemia (choice C) and hypercalcemia (choice D) are not common electrolyte imbalances seen with furosemide use.
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When documenting an incorrect dose of medication administered, which fact related to the incident report should the nurse document in the client's medical record?
- A. Time the medication was given
- B. The client's response to the medication
- C. The dose that was administered
- D. Reason for the error
Correct Answer: A
Rationale: The nurse should document the time the medication was given in the client's medical record when an incorrect dose is administered. Recording the time is crucial for establishing the sequence of events accurately. Choices B, C, and D, though important, are not directly relevant to documenting the incident of administering an incorrect dose of medication. The client's response to the medication, the actual dose administered, and the reason for the error may be documented for overall patient care but are not specifically required in the incident report for an incorrect dose.
A nurse is providing discharge teaching to a client who is postoperative following a total hip arthroplasty. Which of the following instructions should the nurse include?
- A. Cross your legs when sitting to increase circulation.
- B. Bend at the waist when picking up objects.
- C. Avoid crossing your legs when sitting.
- D. Avoid using a raised toilet seat.
Correct Answer: C
Rationale: The correct answer is C: 'Avoid crossing your legs when sitting.' After a total hip arthroplasty, it is important for clients to avoid crossing their legs to prevent complications such as dislocation. Crossing the legs can put strain on the new hip joint, increasing the risk of dislocation. Choice A is incorrect as crossing legs can be harmful. Choice B is incorrect as bending at the waist can strain the hip joint, leading to complications. Choice D is incorrect as using a raised toilet seat is recommended after hip surgery to prevent excessive bending at the hip joint.
A nurse is providing discharge instructions to a client who has a new prescription for warfarin. Which of the following statements indicates a need for further teaching?
- A. I will avoid leafy green vegetables while taking warfarin.
- B. I will have my INR checked regularly while taking warfarin.
- C. I will use a soft toothbrush while taking warfarin.
- D. I will take this medication at the same time each day.
Correct Answer: A
Rationale: The correct answer is A. Clients taking warfarin should avoid leafy green vegetables because they are high in vitamin K, which can interfere with the effectiveness of warfarin by counteracting its anticoagulant effects. Choices B, C, and D are all correct statements related to taking warfarin. Regular INR monitoring is necessary to ensure the medication is within the therapeutic range, using a soft toothbrush reduces the risk of bleeding gums, and taking the medication at the same time daily helps maintain consistent blood levels.
A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include?
- A. Resume a regular diet immediately.
- B. Remove the adhesive bandage after 3 days.
- C. Begin moderate activity immediately.
- D. Take a tub bath instead of a shower.
Correct Answer: B
Rationale: The correct answer is B. The adhesive bandage should be removed 3 days after a laparoscopic cholecystectomy to allow the incision to heal properly. Choice A is incorrect as the client should start with a clear liquid diet and advance to a regular diet as tolerated. Choice C is incorrect because the client should gradually increase activity levels as tolerated. Choice D is incorrect as the client should avoid tub baths and opt for showers to prevent infection and promote healing.
How should pain be assessed in a non-verbal patient?
- A. Observe facial expressions
- B. Use the Wong-Baker faces scale
- C. Assess heart rate
- D. Ask the patient to rate their pain
Correct Answer: A
Rationale: Observing facial expressions is essential in assessing pain levels in non-verbal patients. Non-verbal cues, such as facial grimacing, furrowed brows, or clenched jaws, can provide valuable information about the patient's pain experience. Using the Wong-Baker faces scale or assessing heart rate may not be as effective in non-verbal patients as they are unable to communicate their pain through these methods. Asking the patient to rate their pain is also not suitable for non-verbal patients as they may not have the ability to verbally communicate their pain levels.