Nokea
You are reviewing the drug list of an elderly client who is on several medications prescribed by different specialists for various health problems. The client reports 'lately there has been a roaring sound in my ears.' You notify the prescriber of which medication?
- A. gentamicin sulfate (Garamycin)
- B. metoprolol (Lopressor)
- C. amoxicillin (Amoxil)
- D. warfarin (Coumadin)
Correct Answer: A
Rationale: Gentamicin is an ototoxic medication that can cause tinnitus or hearing loss, warranting notification of the prescriber.
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A patient who had major surgery is experiencing emotional stress as well as physiologic stress from the effects of surgery. What can this stress cause?
- A. Diuresis
- B. Hyperkalemia
- C. Fluid retention
- D. Impaired blood coagulation
Correct Answer: C
Rationale: Surgical stress triggers hormonal responses leading to fluid retention.
Why are older adults more likely to develop hypovolemic shock?
- A. Low-activity lifestyle
- B. Altered cardiac function
- C. Decreased percentage of body water
- D. Decline in muscle strength and bone mass
Correct Answer: C
Rationale: Older adults have less total body water, making them more susceptible to fluid losses and hypovolemic shock.
Paralytic ileus may occur as a postoperative complication. Which of the following patients would cause you the greatest concern about the development of paralytic ileus?
- A. Kim, a 27-year-old postlaparoscopic appendectomy.
- B. Joyce, a 39-year-old post–open right hemicolectomy.
- C. Nancy, a 56-year-old postmediastinoscopy.
- D. John, a 47-year-old post–total joint replacement.
Correct Answer: B
Rationale: Open abdominal surgeries increase the risk of paralytic ileus.
A nurse is assessing a client with a history of seizures. Which assessment finding requires immediate intervention?
- A. The client is experiencing an aura.
- B. The client's antiseizure medication level is within the therapeutic range.
- C. The client has been seizure-free for 2 years.
- D. The client's seizure activity lasts longer than 5 minutes.
Correct Answer: D
Rationale: The correct answer is D because prolonged seizures lasting longer than 5 minutes can lead to status epilepticus, a medical emergency that can cause brain damage or even death. Immediate intervention is necessary to stop the seizure activity. Auras (A) are warning signs of an impending seizure and do not require immediate intervention. Antiseizure medication within therapeutic range (B) indicates proper management. Being seizure-free for 2 years (C) is a positive outcome but does not require immediate intervention unless a seizure occurs.
A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active, and has no known risk factors for PE. What action by the nurse is most appropriate?
- A. Encourage the client to walk for 5 minutes each hour.
- B. Refer the client for smoking cessation classes.
- C. Teach the client about factor V Leiden testing.
- D. Explain to the client that sometimes no cause for the disease is found.
Correct Answer: C
Rationale: The correct answer is C because teaching the client about factor V Leiden testing is important in this scenario. Factor V Leiden is a genetic mutation that increases the risk of blood clot formation, including pulmonary embolism. Since the client has no known risk factors for PE, testing for this specific genetic mutation can help identify an underlying cause. Encouraging walking (choice A) is generally beneficial but may not address the root cause. Referring for smoking cessation (choice B) is not relevant in this case. Explaining that sometimes no cause is found (choice D) is not proactive and may lead to missed opportunities for prevention.