A client is admitted for an MRI (magnetic resonance imaging). The nurse should question the client regarding:
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Solution
Answer A is correct. The client will be asked to remain still during portions of the exam. If the client has difficulty hearing, accommodations for the inability to follow instructions will need to be made. Answer B is incorrect because clients with a titanium joint replacement can have an MRI (magnetic resonance imaging). Answer C is incorrect because the client will not have antibiotics administered in preparation for the exam. Answer D is incorrect because the client will not need to move his feet during the exam.
A client with AIDS is taking Zovirax (acyclovir). Which nursing intervention is most critical during the administration of acyclovir?
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Solution
Answer D is correct. Clients taking Acyclovir should be encouraged to drink plenty of fluids because renal impairment can occur. Answer A is incorrect because there is no need to limit activity. Answer B is incorrect because there is no need to encourage a high-carbohydrate diet. Use of an incentive spirometer is not specific to clients taking Acyclovir, so answer C is incorrect.
Which of the following test should be performed before beginning a prescription of Accutane?
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Solution
Answer B is correct. Accutane is contraindicated for use by pregnant clients because it causes teratogenic effects. Answers A, C, and D are incorrect because calcium levels, apical pulse, and creatinine levels are not necessary.
A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary tract infection. The client should be taught that the medication can:
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Solution
Answer B is correct. Clients taking Pyridium should be taught that the medication will turn the urine orange or red. Answers A, C, and D are incorrect because this drug does not cause diarrhea, mental confusion, or changes in taste. Pyridium can cause a yellowish color to skin and sclera if taken in large doses.
Damage to the VII cranial nerve results in:
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Solution
Answer A is correct. The facial nerve is cranial nerve VII. If damage occurs, the client will experience facial pain. Answer B is incorrect because the olfactory nerve is responsible for smell. Answer D is incorrect because the auditory nerve is responsible for hearing loss and tinnitus. Answer C is incorrect because eye movement is controlled by the Trochear or C IV.
The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. Which of the client’s statements indicates the need for additional teaching?
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Solution
Answer C is correct. Mothers who plan to breastfeed should drink plenty of liquids. Four glasses in a 24-hour period is not enough. Wearing a support bra is a good practice for the mother who is breastfeeding as well as the mother who plans to bottle feed, so answer A is incorrect. Expressing milk from the breast will stimulate milk production, so answer B is incorrect. Answer D is incorrect because allowing the water to run over the breast will also facilitate “letdown,” when the milk begins to be produced.
The client using a diaphragm should be instructed to:
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Solution
Answer B is correct. The client using a diaphragm should keep the diaphragm in a cool location. She should refrain from leaving the diaphragm in longer than 8 hours, not 4, so answer A is incorrect. She should have the diaphragm resized when she gains or loses 10 pounds, so answer C is incorrect. Answer D is incorrect because the client should be resized if she has abdominal surgery
The client has an order for a trough to be drawn on the client receiving Vancomycin. The nurse is aware that the nurse should contact the lab in order for them to collect the blood:
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Solution
Answer B is correct. A trough level should be drawn 30 minutes before the third or fourth dose. Answers A, C, and D are incorrect times to draw blood levels.
Which action by the nurse indicates understanding of herpes zoster?
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Solution
Answer B is correct. Herpes zoster is shingles. Clients with shingles should be placed in contact precautions. Wearing gloves during care will prevent transmission of the virus. Covering the lesions with a sterile gauze is not necessary, so answer A is incorrect. Antibiotics are not prescribed for herpes zoster, so answer C is incorrect. Answer D is incorrect because oxygen is not necessary.
To maintain Bryant’s traction, the nurse must make certain that the child’s:
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Solution
Answer B is correct. Bryant’s traction is used for fractured femurs and dislocated hips. The hips should be elevated 15° off the bed. Answer A is incorrect because the hips should not be resting on the bed. Answer C is incorrect because the hips should not be above the level of the body. Answer D is incorrect because the hips should not be flat on the bed.