Nokea
While assisting in caring for a pregnant client receiving intravenous magnesium sulfate for preeclampsia management, a nurse notes the client's absent deep tendon reflexes. What determination should the nurse make based on this data?
- A. The magnesium sulfate is effective.
- B. The infusion rate needs to be increased.
- C. The client is experiencing cerebral edema.
- D. The client is experiencing magnesium toxicity.
Correct Answer: D
Rationale: When a pregnant client receiving intravenous magnesium sulfate for preeclampsia management exhibits absent deep tendon reflexes, this indicates magnesium toxicity. Magnesium toxicity can occur as a complication of magnesium sulfate therapy, leading to suppressed reflexes. It is crucial for the nurse to recognize this sign promptly and report it to prevent further complications or harm to the client.
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A client is being cared for by a nurse due to severe back pain, and codeine sulfate has been prescribed. Which of the following should the nurse include in the plan of care while the client is taking this medication?
- A. Restrict fluid intake.
- B. Monitor bowel activity.
- C. Monitor for hypertension.
- D. Monitor peripheral pulses.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client is receiving instructions from a healthcare provider about intranasal desmopressin acetate (DDAVP). The healthcare provider explains that which of the following is a side effect of the medication?
- A. Headache
- B. Vulval pain
- C. Runny nose
- D. Flushed skin
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client is prescribed atorvastatin (Lipitor) for hyperlipidemia. Which instruction should the nurse include in the teaching plan?
- A. Take the medication in the morning.
- B. Avoid consuming grapefruit juice.
- C. Increase intake of dairy products.
- D. Take the medication with food.
Correct Answer: B
Rationale: The correct instruction for the nurse to include in the teaching plan is to advise the client to avoid consuming grapefruit juice. Grapefruit juice can increase the risk of atorvastatin (Lipitor) toxicity by inhibiting its metabolism. Atorvastatin is typically taken in the evening because cholesterol synthesis occurs at night. Increasing dairy intake is not specifically recommended for atorvastatin use, and the medication can be taken with or without food.
The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?
- A. Constipation
- B. Abdominal pain
- C. An episode of diarrhea
- D. Hematest-positive nasogastric tube drainage
Correct Answer: C
Rationale: Loperamide hydrochloride (Imodium) is an antidiarrheal medication commonly used to manage episodes of diarrhea. It works by slowing down gut movement and reducing the frequency of bowel movements. Loperamide is not indicated for constipation, abdominal pain, or hematest-positive nasogastric tube drainage. It is specifically useful in acute and chronic diarrhea, such as in cases of inflammatory bowel disease, to help control symptoms and decrease fluid loss.
Mafenide acetate (Sulfamylon) is prescribed for a client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action?
- A. Notifying the registered nurse
- B. Discontinuing the medication
- C. Informing the client that this is normal
- D. Applying a thinner film than prescribed to the burn site
Correct Answer: C
Rationale: The correct action is to inform the client that local discomfort and burning are normal reactions to Mafenide acetate. This medication is used to treat burns by reducing bacteria in avascular tissues. Discontinuing the medication or applying a thinner film than prescribed is not necessary or recommended in this situation.