Nokea
Which of the following clients should refrain from therapy with the thiazide diuretic hydrochlorothiazide?
- A. a client with renal impairment
- B. a client with hypertension
- C. a client with diabetes mellitus, type II
- D. a client with renal calculi (kidney stones)
Correct Answer: C
Rationale: The correct answer is a client with diabetes mellitus, type II. Thiazide diuretics like hydrochlorothiazide can cause metabolic abnormalities, including elevated blood glucose levels. This increase is linked to diuretic-induced potassium deficiency, which reduces insulin secretion, leading to higher plasma glucose levels. Thiazides are commonly used in clients with renal impairment and hypertension. Moreover, thiazides decrease calcium excretion, reducing the risk of renal calculi, so it is not contraindicated for clients with kidney stones. Therefore, clients with diabetes mellitus, type II should avoid therapy with hydrochlorothiazide due to the potential adverse effects on blood glucose levels.
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The mother of a newborn child is very upset. The child has a cleft lip and palate. The type of crisis this mother is experiencing is:
- A. reactive.
- B. maturational.
- C. situational.
- D. adventitious.
Correct Answer: C
Rationale: The mother is experiencing a situational crisis as the unexpected birth of a child with a cleft lip and palate has placed her in a challenging situation she did not anticipate. This type of crisis is triggered by specific events and circumstances. Choice A, reactive, implies responding to a stressor after it has occurred, which is not the case here. Choice B, maturational, refers to stress related to developmental stages, not to external events like the child's condition. Choice D, adventitious, involves crises resulting from events outside one's control, such as natural disasters, which do not apply in this scenario.
Why might the physician order antibiotics to be given through the central venous access device (CVAD) rather than through a peripheral IV line if the CVAD becomes infected?
- A. To prevent infiltration of the peripheral line
- B. To reduce the pain and discomfort associated with antibiotic administration in a small vein
- C. To lessen the chance of an allergic reaction to the antibiotic
- D. To attempt to eliminate microorganisms in the catheter and prevent having to remove it
Correct Answer: D
Rationale: When a patient's central venous access device (CVAD) becomes infected, administering antibiotics through the line is essential to attempt to eliminate microorganisms within the catheter. The goal is to prevent the necessity of removing the catheter, which might be required if the infection persists. Choice A, 'To prevent infiltration of the peripheral line,' is incorrect as the priority is addressing the catheter infection, not preventing issues with a peripheral line. Choice B, 'To reduce the pain and discomfort associated with antibiotic administration in a small vein,' is not relevant to the rationale for choosing the CVAD for antibiotic administration. Choice C, 'To lessen the chance of an allergic reaction to the antibiotic,' is also incorrect as the main focus is managing the catheter-associated infection rather than allergy prevention.
The nurse is caring for a dying client who has persistently requested that the nurse 'help her to die and be in peace.' According to the Code of Ethics for Nurses, the nurse should:
- A. Ask the client whether she has signed the advance directives document.
- B. Tell the client that he or she will ask another nurse to care for her.
- C. Instruct the client that only a physician can legally assist in suicide.
- D. Try to make the client as comfortable as possible, but refuse to assist in death.
Correct Answer: D
Rationale: The correct answer is to try to make the client as comfortable as possible but refuse to assist in death. According to the Code of Ethics for Nurses, nurses are committed to providing compassionate care, respecting the dignity and rights of the dying person. In this situation, it is important for the nurse to focus on providing comfort and support to the client while upholding ethical standards. Choice A is incorrect because discussing advance directives does not address the immediate request for assistance in dying. Choice B is incorrect as it does not address the ethical dilemma presented. Choice C is incorrect because instructing the client that only a physician can assist in suicide does not fully address the complexity of the situation or the nurse's role in providing end-of-life care.
Before administering Theodur to a 10-year-old being treated for asthma, the nurse should check the:
- A. Urinary output
- B. Blood pressure
- C. Pulse
- D. Temperature
Correct Answer: C
Rationale: The correct answer is to check the pulse. Theodur is a bronchodilator used in asthma treatment, and one of the side effects is tachycardia (increased heart rate). Therefore, it is essential to assess the pulse rate before administering Theodur to monitor for any potential tachycardia. Checking urinary output (Choice A), blood pressure (Choice B), and temperature (Choice D) are not directly related to the immediate side effects of bronchodilators like Theodur in this context, making them unnecessary assessments.
While walking in the hallway of an acute care unit of the hospital, the nurse overhears the change of shift report. What should the nurse do?
- A. Make the charge nurse on the unit aware of the situation so that they can take the necessary steps to maintain the confidentiality of the information being reported.
- B. Disregard the information because it changes quickly on the acute care unit and is outdated within 2-3 hours anyway.
- C. Return to their own unit and not disclose that confidential information has been overheard.
- D. Ignore the situation.
Correct Answer: A
Rationale: To protect the confidentiality of the information being reported, the nurse should make the charge nurse on the unit aware of the situation. This allows the charge nurse to take necessary steps to maintain confidentiality and ensure that the information is communicated in an appropriate and private manner. Disclosing the situation to the charge nurse is essential to address any breaches in confidentiality and uphold professional standards of privacy and ethics. Disregarding the information, returning to their own unit without disclosure, or ignoring the situation altogether would not address the breach of confidentiality and could lead to further issues regarding patient privacy and trust.