A client on the postpartum unit has a proctoepisiotomy. The nurse should anticipate administering which medication?
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Solution
Answer B is correct. The client with a protoepisiotomy will need stool softeners such as docusate sodium. Answer A is incorrect because suppositories are given only with an order from the doctor. Answer C is incorrect because Methergine (methylergonovine) is a drug used to contract the uterus. Answer D is incorrect because Ritalin (methylphenidate) is a drug given for hyperactivity.
The nurse is preparing to discharge a client with a long history of polio. The nurse should tell the client that:
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Solution
Answer C is correct. The client with polio has muscle weakness. Periods of rest throughout the day will conserve the client’s energy. Answer A is incorrect because taking a hot bath can cause burns; however, a warm bath would be helpful. Answer B is incorrect because strenuous exercises are not advisable. Answer D is incorrect because visual disturbances are directly associated with polio; however, there is no guarantee that these visual disturbances can be corrected by glasses.
A 6-month-old client is placed on strict bed rest following a hernia repair. Which toy is best suited to the client?
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Solution
Answer C is correct. Answer A is incorrect because a 6-month-old is too old for the colorful mobile. Answers B and D are incorrect because he is too young to play with the electronic game or the 30-piece jigsaw puzzle. The best toy for this age is the cars in a plastic container.
The physician has ordered a CAT (computerized axial tomography) scan for a client with a possible cerebral aneurysm. Which information is most important to the nurse who is preparing the client for the CAT scan? The client:
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Solution
Answer C is correct. Answer C is correct because a history of allergies to oysters may indicate a potential allergy to the dye used in the contrast medium. Answer A is incorrect because the client can have a CAT scan if she is having her menses. Answer B is incorrect because a history of claustrophobia is not related to having a CAT scan. Answer D is incorrect because a client with sensory hearing loss can have a CAT scan.
When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to:
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Solution
Answer A is correct. If the nurse checks the fundus and finds it to be displaced to the right or left, this is an indication of a full bladder. Answer B is incorrect because this finding is not associated with hypotension or clots. Oxytoxic drugs (Pitocin) are used to contract the uterus, but the fact that the client did or did not receive Pitocin does not help with the plan of action; therefore, answer C is incorrect. Answer D is incorrect because expulsion of small clots is normal; it has nothing to do with displacement to the right.
A client is admitted to the hospital following a gunshot wound to the abdomen. A temporary colostomy is performed, and the physician writes an order to irrigate the proximal end of the colostomy. The nurse is aware that the proximal end of a doublebarrel colostomy is the end that:
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Solution
Answer C is correct. The proximal end of the double-barrel colostomy is the end toward the small intestines. This end is on the client’s right side. The distal end, in answers A, B, and D, is on the client’s left side.
The physician has prescribed rantidine (Zantac) for a client with erosive gastritis. The nurse should administer the medication:
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Solution
Answer B is correct. Zantac (rantidine) is a histamine blocker. This drug should be given with meals, for optimal effect. It should not be given before meals, so answer A is incorrect. Tagamet (cimetidine) is a histamine blocker that can be given in one dose at bedtime, so answer C is incorrect. These drugs should not be given after meals, so answer D is incorrect.
A client tells the nurse that she is allergic to eggs, dogs, rabbits, and chicken feathers. Which order should the nurse question?
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Solution
Answer B is correct. The client who is allergic to dogs, eggs, rabbits, and chicken feathers is most likely allergic to the rubella vaccine. The client who is allergic to neomycin is also at risk. Answers A, C, and D are incorrect because there is no danger to the client if he has an order for a TB skin test, ELISA test, or chest x-ray.
A client with rheumatoid arthritis is receiving Methotrexate. After reviewing the client’s chart, the physician orders Wellcovorin (leucovorin calcium). The rationale for administering leucovorin calcium to a client receiving Methotrexate is to:
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Solution
Answer D is correct. Methotrexate is a folic acid antagonist. Leucovorin is the drug given for toxicity to this drug. Answers A, B, and C are incorrect because the drug is not used to treat iron-deficiency anemia, create a synergistic effects, or increase the number of circulating neutrophils.
The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
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Solution
Answer C is correct. NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. NPH insulin onsets in 90–120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect, but the client should eat a bedtime snack.