A 4-year old child is brought by her grandmother in the emergency room due to fever, chills, and difficulty walking. The nurse tries to remove the excessive clothing of the child but is reluctant. After a thorough assessment, the nurse also noted bruises around the genital area. Which of the following interventions should the nurse… Read More »
A client with a history of emboli is receiving Lovenox (enoxaparin). Which drug is given to counteract the effects of enoxaparin? A. Methergine B. Protamine sulfate C. Calcium gluconate D. Aquamephyton Correct Answer: B. Protamine sulfate Option B: Protamine sulfate is given to counteract the effects of… Read More »
The nurse is caring for a client with systemic lupus erythematosus (SLE). The major complication associated with systemic lupus erythematosus is: A. Meningitis B. Nephritis C. Cardiomegaly D. Desquamation Correct Answer: B. Nephritis Option B: Systemic lupus erythematosus is a form of lupus and an autoimmune disease… Read More »
A client has returned to his room following an esophagoscopy. Before offering fluids, the nurse should give priority to assessing the client’s: A. Level of consciousness B. Movement of extremities C. Urinary output D. Gag reflex Correct Answer: D. Gag reflex Option D: The client’s gag reflex is depressed… Read More »
The physician has ordered a low-potassium diet for a child with acute glomerulonephritis. Which fruit is suitable for the child with potassium restrictions? A. Raisins B. Cantaloupe C. Blueberries D. Apricots Correct Answer: C. Blueberries Option C: Patients with decreased kidney function are at risk for hyperkalemia.… Read More »
The nurse is caring for an 8-year-old following a routine tonsillectomy. Which finding should be reported immediately? A. Reluctance to swallow B. Drooling of blood-tinged saliva C. An axillary temperature of 99°F D. High-pitched sound when breathing Correct Answer: D. High-pitched sound when breathing Options D: One complication… Read More »
The physician has ordered Stadol (butorphanol) for a postoperative client. The nurse knows that the medication is having its intended effect if the client: A. States that he is feeling less nauseated B. Has an increased urinary output C. Asks for extra servings on his meal tray D. Is asleep 30… Read More »
Which finding is the best indication that a client with ineffective airway clearance needs suctioning? A. Oxygen saturation B. Respiratory rate C. Breath sounds D. Arterial blood gases Correct Answer: C. Breath sounds Option C: Changes in breath sounds such as crackles are the best indication of the need… Read More »
The nurse is to administer digoxin elixir to a 6-month-old with a congenital heart defect. The nurse auscultates an apical pulse rate of 100 beats per minute. The nurse should: A. Record the heart rate and call the physician B. Record the heart rate and administer the medication C. Administer the medication… Read More »
The nurse is assessing a multigravida, 36 weeks gestation for symptoms of pregnancy-induced hypertension and preeclampsia. The nurse should give priority to assessing the client for: A. Ankle edema B.Diminished reflexes C. Facial swelling D.Pulse deficits Correct Answer: C. Facial swelling Option C: The nurse should pay close attention… Read More »