Nokea
Which of the following actions should the nurse take?
- A. Encourage the client to watch television
- B. Administer a dose of atomoxetine to decrease anxiety
- C. Teach the client how to meditate
- D. Sit with the client to provide a sense of security.
Correct Answer: D
Rationale: Providing a calming presence can help de-escalate panic symptoms.
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The nurse should identity which of the following conditions as a contraindication for receiving this treatment?
- A. Hypertension
- B. Obesity
- C. Hypothyroidism
- D. Herpes zoster
Correct Answer: D
Rationale: The correct answer is D. Herpes zoster is a contraindication for certain treatments because it is a viral infection that can worsen with immunosuppressive therapy. Hypertension, obesity, and hypothyroidism are not direct contraindications for receiving the treatment mentioned. Hypertension can be managed, obesity and hypothyroidism do not directly impact the treatment's efficacy. Herpes zoster, on the other hand, can lead to serious complications if the treatment suppresses the immune system. It is crucial to address active infections before starting immunosuppressive therapy to prevent further complications.
Which of the following statements by the client indicate an understanding of the discharge teaching? Select all that apply.
- A. I will eat small, frequent meals.
- B. I should expect my bowel movements to be pale in color.
- C. I will limit my morning coffee to no more than two cups.
- D. I will notify my provider if my urine is dark.
- E. I will eat fish for dinner at least twice per week.
Correct Answer: A,D,E
Rationale: The correct statements (A, D, E) demonstrate an understanding of discharge teaching. A shows awareness of dietary recommendations post-discharge. D indicates knowledge of abnormal urine color as a reason to notify the provider. E reflects comprehension of incorporating fish in the diet for health benefits. The incorrect choices (B, C) suggest misconceptions. B is inaccurate as pale bowel movements may indicate a liver issue. C may be harmful as coffee can interfere with medication.
A nurse is caring for a client who is in a coma and is scheduled for a surgical procedure. Which of the following actions should the nurse take?
- A. Send the unsigned informed consent form to the facility's risk manager.
- B. Determine if the client's health care surrogate is aware of the risks and benefits of the procedure.
- C. Ensure that the client's family supports the provider's decision for surgery,
- D. Determine if the procedure is medically necessary for the client.
Correct Answer: B
Rationale: The correct answer is B: Determine if the client's health care surrogate is aware of the risks and benefits of the procedure. This is important because the client is in a coma and unable to provide informed consent. The health care surrogate acts on behalf of the client and must be fully informed about the procedure to make decisions in the client's best interest. Sending the unsigned consent form to the risk manager (A) is not appropriate as it does not address the issue of informed consent. Ensuring family support (C) is important but does not address the legal requirement of informed consent. While determining medical necessity (D) is important, in this case, the primary concern is obtaining informed consent.
Which of the following should the nurse identify as an expected finding?
- A. Weak femoral pulses
- B. Frequent nosebleeds
- C. Upper extremity hypotension
- D. Increased intracranial pressure
Correct Answer: A
Rationale: Coarctation of the aorta often results in weak or absent femoral pulses due to reduced blood flow to the lower extremities.
Which of the following actions should the nurse plan to take?
- A. The nurse should use a filter needle to withdraw the medication.
- B. The nurse should break the neck of the ampule toward their body
- C. The nurse should use the same needle to draw up and inject the client
- D. The nurse should dispose of the ampule in the trash can.
Correct Answer: A
Rationale: The correct answer is A: The nurse should use a filter needle to withdraw the medication. This is the correct action as filter needles help prevent the introduction of particulate matter or impurities into the medication, ensuring patient safety. Using a filter needle also reduces the risk of needlestick injuries and contamination.
Choice B is incorrect as breaking the neck of the ampule towards the body increases the risk of injury due to glass shards flying towards the nurse. Choice C is incorrect as it violates safe medication administration practices by risking contamination. Choice D is incorrect as ampules should be disposed of in a sharps container, not the trash can.