Nokea
Which of the following reasons explains why meperidine (Demerol) is not recommended for chronic cancer-related pain?
- A. It has a high potential for abuse.
- B. It has agonist-antagonist properties.
- C. It must be given intramuscularly to be effective.
- D. It contains a metabolite that causes seizures.
Correct Answer: D
Rationale: Meperidine's metabolite, normeperidine, accumulates with repeated dosing and can cause seizures, making it unsuitable for chronic cancer pain.
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The nurse is reviewing the chart information for a client with increased ascites. The data include: temperature 37.2°C; heart rate 118; shallow respirations 26; blood pressure 128/76; and SpO2 89% on room air. Which action should receive priority by the nurse?
- A. Assess heart sounds.
- B. Obtain an order for blood cultures.
- C. Prepare for a paracentesis.
- D. Raise the head of the bed.
Correct Answer: D
Rationale: Low SpO2 (89%) and shallow respirations indicate respiratory compromise, likely from ascites pressing on the diaphragm. Raising the head of the bed (D) improves breathing. Heart sounds (A), blood cultures (B), and paracentesis (C) are secondary.
Which of the following is not a realistic outcome to establish with a client who has multiple sclerosis (MS)? The client will:
- A. Develop joint mobility.
- B. Develop muscle strength.
- C. Develop cognition.
- D. Develop mood elevation.
Correct Answer: C
Rationale: Developing cognition is not realistic, as MS can cause cognitive decline that is not typically reversible. Improving mobility, strength, and mood are achievable with therapy and support.
A client with Ménière'sdisease continues to have disabling attacks of vertigo and elects to have a labyrinthectomy. A priority nursing diagnosis for the client before surgery is:
- A. Deficient diversional activity related to inability to participate secondary to vertigo.
- B. Risk for injury related to vertigo.
- C. Powerlessness related to inability to influence effects of disease process.
- D. Social isolation related to hearing loss.
Correct Answer: B
Rationale: Risk for injury related to vertigo is the priority due to the high risk of falls and accidents during vertigo attacks, which is a significant concern pre-surgery.
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings requires further evaluation?
- A. Heart rate 57 bpm
- B. SpO2 of 94% on room air
- C. Blood pressure in 1 mm/s
- D. Ankle brachial index of 0.65
Correct Answer: D
Rationale: An ankle-brachial index (ABI) of 0.65 is significantly below the normal range (0.9–1.3), indicating potential peripheral vascular disease (PVD) due to arterial insufficiency. This finding warrants further evaluation, especially given the client's symptoms of claudication (pain during exercise relieved by rest) and smoking history, which are risk factors for PVD. The other options€”heart rate, SpO2, and blood pressure€”are either normal or irrelevant in this context.
Which medication requires monitoring for a client with Parkinson's disease?
- A. Antihypertensives.
- B. Levodopa.
- C. Antidepressants.
- D. Antihistamines.
Correct Answer: B
Rationale: Levodopa requires monitoring for efficacy and side effects, as it is a primary treatment for Parkinson's symptoms.