1220 FINAL EXAM Practice Q's
A client with peripheral arterial disease has received instructions form the nurse about how to limit the progression of the disease. The nurse determines that the client needs further teaching if which statement was made by the client?
"A heating pad on my leg will help soothe the leg pain."
After a cholecystectomy a client asks whether there are any dietary restrictions that must be followed. The nurse evaluates that the dietary teaching is understood when the client tells a family member:
"I WILL PROBABLY BE ABLE TO TOLERATE A REGULAR DIET AFTER THIS TYPE OF SURGERY."
The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care?
"I empty the urinary collection bag when it is two-thirds full."
The clinic nurse instructs a client with diabetes mellitus about how to prevent diabetic ketoacidosis on days when the client is feeling ill. Which statement by the client indicates the need for further teaching?
"I need to stop my insulin if I am vomiting."
The nurse has conducted discharge teaching with a client diagnosed with TB, who has been receiving medication for 1 ½ weeks. The nurse determines that the client has understood the information if the client makes which statement?
"I should not be contagious after 2 to 3 weeks of medication therapy."
The nurse provides discharge instructions to a client who is taking warfarin. Which statement, by the client, reflects the need for further teaching?
"I will take Ecotrin (enteric-coated aspirin) for my headaches because its coated."
The nurse is reviewing home care instructions with an older client who has type 1 diabetes mellitus and a history of diabetic ketoacidosis (DKA). The client's spouse is present when the instructions are given. Which statement by the spouse indicates that further teaching is necessary?
"If he is vomiting, I shouldn't give him any insulin."
The nurse is instructing a client with diabetes mellitus regarding hypoglycemia. Which statement by the client indicates the need for further teaching?
"If hypoglycemia occurs, I need to take my regular insulin as prescribed."
Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease?
Instruct the client to walk daily for at least 30 minutes-Walking will increase circulation and decrease intermittent claudication.
The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record?
Intermittent claudication
Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering the medication understands that which is the primary action of this medication?
It competitively binds to estrogen receptors on tumors and other tissue targets.
The nurse is caring for a client with type 1 diabetes mellitus. Because the client is at risk for hypoglycemia, which of the instructions should the nurse teach the client to follow?
Keep glucose tablets and subcutaneous glucagon available.
When caring for a client with an internal radiation implant the nurse should observe which principles? Select all that apply.
Keeping pregnant women out of the client's room, Placing the client in a private room with a private bath, Wearing a lead shield when providing direct client care
Rapid-acting Insulin (bolus)
Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Injected 0 to 15 minutes before meal Onset of action 15 minutes
A client with a hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?
Lying recumbent following meals
A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this clients plan of care to delay the onset of microvascular and macro-vascular complications?
Maintain tight glycemic control and prevent hyperglycemia
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for a cardiac catherization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?
Metformin (Glucophage)
Biguanides
Metformin (Glucophage) Reduce glucose production by liver Enhance insulin sensitivity at tissues Improve glucose transport into cells Does not promote weight gain
A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. You note that no pulse is palpable in the left foot and that it is cold and pale. Which action should you take next?
NOTIFY THE CLIENT'S PHYSICIAN ABOUT THE CHANGE IN STATUS
Intermediate-acting Insulin (basal)
NPH (Humulin N) Onset of action 1-4 hours Duration lasts during the day
A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip?
BLOOD PRESSURE IS 88/46
The nurse knows that the client understands the teaching concerning a low-fat, low-cholesterol diet when the client selects which meal?
Baked chicken, baked potato, and skim milk
The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the HCP?
Bronchospasm
A client has returned from the cardiac catheterization laboratory after a balloon valvuloplasty for mitral stenosis. Which finding requires immediate nursing action?
CLIENT HAS BECOME MORE SOMNOLENT.
When teaching a client with tuberculosis about recovery after discharge from the hospital, the nurse reinforces that the treatment measure with the highest priority is:
CONSISTENTLY TAKING PRESCRIBED MEDICATIONS
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
Calcium level- Tamoxifen may increase calcium, cholesterol, and triglyceride levels.
You are monitoring a 53-year-old client who is undergoing a treadmill stress test. Which client finding will require the most immediate action?
Chest pain 3/10- Chest pain is the only irregular response to exercise and may indicate ischemia.
Long-acting Insulin (basal)
-insulin glargine (Lantus)Onset of action 2-4 hours -insulin detemir (Levemir)Onset of action 1 hour -Injected once a day at bedtime or in the morning -Duration lasts during the dayNursing Safety Priority -Drug Alert!!!Do not mix any other insulin type with insulin glargine (Lantus), insulin detemir (Levemir), or any of the premixed insulin formulations such as Humalog Mix 75/25.
The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH at 1700 each day. The client should be instructed that the greatest risk for hypoglycemia will occur at about what time?
0100, WHILE SLEEPING
The nurse is preparing to suction a client via a tracheostomy tube. The nurse should plan to limit the suctioning time to a maximum of which time period?
10 seconds
The nurse is teaching a client who had been newly diagnosed with diabetes mellitus about blood glucose monitoring. The nurse should teach the client to report glucose levels that consistently exceed which level?
250mg/dL
A Tuberculin skin test with purified protein derivative (PPD) tuberculin is performed as part of a routine physical examination. The nurse instructs the client to make an appointment so the test can be read in:
3 days
A nurse is participating in a diabetes screening program. Who are at risk for developing type 2 diabetes? (Select all that apply)
A 32-YEAR-OLD FEMALE WHO GAVE BIRTH TO A 9 ½ LB INFANT, A 44 YEAR-OLD NATIVE AMERICAN WHO HAS A BODY MASS INDEX OF 32, A 55 YEAR OLD ASIAN WHO HAS HYPERTENSION AND TWO SIBLINGS WITH TYPE 2 DIABETES, A 12 YEAR OLD WHO IS OVERWEIGHT
The community health nurse is conducting an educational session with community members regarding the symptoms associated with TB. Which is one of the first manifestations associated with TB?
A cough with the expectoration of mucoid sputum
An early finding that indicates that a client is hypertensive is:
A diastolic blood pressure that remains greater than 90mm Hg
The nurse is caring for a client hospitalized with an acute exacerbation of COPD. Which finding would the nurse expect to note on assessment of this client? Select all that apply.
A hyperinflated chest noted on the chest x-ray, Decreased oxygen saturation with mild exercise
Phenazopyridine (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse should provide the client with which information regarding this medication?
A reddish orange discoloration of the urine may occur
The HCP prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential HTN. Which statement is the most appropriate rationale for administering this medication?
ACE inhibitors prevent vasoconstriction and sodium and water retention- Prevents conversion of Angiotensin I to II, which prevents vasoconstriction and the retention of sodium and water.
A client just admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first?
ADMINISTER OXYGEN VIA NASAL CANNULA
The healthcare provider prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to delegate to an experiences LPN who is working with you in the ED? (Select all that apply)
ATTACHING CARDIAC MONITOR LEADS, OBTAINING A 12-LEAD EKG, HAVING THE CLIENT CHEW AND SWALLOW ASPIRIN 162 MG
A client receiving chemotherapy and a steroid has a white blood cell count of 12,000/mm3 and a red blood cell count of 4.5 million/mm3. What is the priority instruction that the nurse should teach the client?
AVOID LARGE CROWDS AND PERSONS WITH INFECTIONS
What instructions should the nurse give a client experiencing signs and symptoms related to decreased arterial insufficiency? (Select all that apply)
AVOID SMOKING AND EXPOSURE TO THE COLD, TAKE ASPIRIN OR CLOPIDOGREL AS PRESCRIBED, USE ADDITIONAL BED CLOTHES AT NIGHT
A client with A-fib is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results?
Activated partial thromboplastin time of 60 seconds
The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for TB. Which instructions should the nurse include on the list? Select all that apply.
Activities should be resumed gradually, A sputum culture is needed every 2-4 weeks once medication therapy is initiated, Respiratory isolation is not necessary because the family members already have been exposed, Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply.
Administer antacids as prescribed, Encourage coughing and deep breathing, Administer anticholinergics as prescribed, Give meperidine (Demerol) as prescribed for pain
You are working in the ED caring for a client who was just admitted with left anterior chest pain, possible ACS. Which action will you take first?
Administer sublingual nitro- Pain management is the priority; make sure that you take vitals before administering
An older adult develops severe bone marrow suppression from chemotherapy for cancer. The nurse should:
Advice use of a soft toothbrush for oral hygiene
The nurse develops a plan of care for an older client with diabetes mellitus. It is important that the nurse plans to complete which action first?
Assess the client's ability to read label markings on syringes and blood glucose monitoring equipment.
The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge teaching should be provided to the client?
Avoid green, leafy vegetables and notify the HCP of red or brown urine
A nurse teaches a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). Which statement should the nurse include in this clients teaching?
Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs).
You make a home visit to evaluate a hypertensive client who has been taking enalapril (Vasotec). Which finding indicates that you need to contact the health care provider about a change in drug therapy?
Client coughs often during visit- Persistent and irritating cough is a potential SE of ACE inhibitors, and can be solved by changing medications (a change in drug therapy).
Which assessment data would warrant immediate intervention by the nurse?
Client diagnosed with DVT who complains of pain on inspiration
Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease?
Client has numbness and tingling
The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention?
Notify the HCP
A man brought to the emergency department by coworkers and is admitted with possible MI. Several hours later, the client is experiencing severe chest pain. He is diaphoretic, and his pulse rate is 110 beats per minute. The nurse should immediately:
Notify the practitioner and administer the ordered morphine
A nurse cares for a client who has type 1 diabetes mellitus. The client asks, Is it okay for me to have an occasional glass of wine? How should the nurse respond?
One glass of wine is okay with a meal and is counted as two fat exchanges
A client with acute pancreatitis has a blood pressure of 88/40 mm Hg, heart rate of 128 bpm, respirations of 28/min, and Grey Turner's sign. What prescription should the nurse implement first?
PLACE AN INTRAVENOUS LINE
The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. What should the nurse do next?
PLACE CLIENT IN HIGH FOWLER'S POSITION
The nurse is preparing to give a bed bath to an immobilized client with TB. The nurse should wear which item when performing this care?
Particulate respirator, gown, and gloves
The nurse is instructing a patient with type 1 diabetes mellitus about the management of hypoglycemic reactions the nurse instructs the client that hypoglycemia most likely occurs during what time interval after insulin administration?
Peak
You have just given morphine sulfate 4mg IV to a client who has an acute MI. When you evaluate the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action?
Persisting chest pain at 1/10
A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client?
Presence of protein in the urine
The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome?
Promote carbon dioxide elimination
IV heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
Protamine sulfate
A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss?
RAPID, DEEP RESPIRATIONS
A client is admitted to the emergency department with multiple injuries including fractured ribs. Because of the client's fractured ribs, the nurse should assess for signs of:
RESPIRATORY ACIDOSIS
Short-acting Insulin (bolus)
Regular (Humulin R) Injected 30 minutes before meal Onset of action 30 to 60 minutes
An 80-year-old client on the coronary step-down unit tells you that he does not want to take the ordered docusate sodium (Colace) because he does not have any problems with constipation. Which action is most appropriate?
Reinforce that the docusate was prescribed for a good reason
A nurse who is caring for a client experiencing anginal pain expects that it will be:
Relieved by sublingual nitroglycerin
A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take?
Review the clients liver function study results.
The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the pain?
Right upper quadrant, radiating to the right scapula and shoulder
The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes?
STEROIDS
The nurse has a prescription to give a client salmeterol, two puffs, and beclomethasone dipropionate, two puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure?
Salmeterol first and then the beclomethasone
A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria?
Serum osmolarity: 375 mOsm/kg
A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis?
Severe and unrelenting, located in the epigastric area and radiating to the back
A client is admitted to the coronary care unit with a tentative diagnosis of myocardial infarction. What type of pain should the nurse expect the client to describe?
Severe, intense chest pain
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume?
Sitting on the side of the bed and leaning on an overbed table
The client diagnosed with PVD is overweight, has smoked two (2) packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor is the development of atherosclerotic lesions?
Smoking cigarettes
The nurse performs an admission assessment on a client with a diagnosis of TB. The nurse should check the results of which diagnostic test that will confirm this diagnosis?
Sputum culture
The nurse is suctioning a client via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which nursing intervention is most appropriate?
Stop the procedure and reoxygenate the client
The nurse is teaching a class on Coronary Artery Disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis?
Stress
The nurse would expect the urine of a patient with uncontrolled diabetes mellitus to be
Sweet smelling
The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy?
Teach the client and family about the need for hand hygiene
The nurse just received the AM shift report. Which client should the nurse assess FIRST?
The client diagnosed with DVT who is complaining of chest pain- Could be a life-threatening Pulmonary Embolism!
The client diagnosed with essential HTN is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse?
The client has a weight gain of 2kg within 1-2days- This indicates that the loop diuretic is not working effectively!
At 9:00 PM, you admit a 63-year-old with a diagnosis of acute MI. Which finding is most important to communicate to the HCP who is considering the use of fibribolytic therapy with TPA for the client?
The client has had continuous chest pain since 8:00AM
The nurse is caring for clients on a surgical floor. Which client should be assessed first? A. The client who is 4 days post-op for abdominal surgery and is complaining of left calf pain when ambulating B. The client who is 1day post-op hernia repair who has just been able to void 550mL of clear, amber urine C. The client who is 5 days post-op open cholecystectomy who has a T-tube and is being discharged D. Client who is 16hrs post-op hysterectomy complaining of ABD pain and expelling flatus
The client who is 4 days post-op for abdominal surgery and is complaining of left calf pain when ambulating
The nurse is monitoring a client who is taking propranolol. Which assessment data indicates a potential serious complication associated with this medication?
The development of audible expiratory wheezes
A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition?
Trauma to the bladder or abdomen
You are working in the ED when a client arrives reporting substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test result will be most useful in determining whether you should anticipate implementing the acute coronary syndrome (ACS) standard protocol?
Troponin I level- Troponin I increases 3 hours after onset and is therefore most specific
A nurse teaches a client with diabetes mellitus who is experiencing numbness and reduced sensation. Which statement should the nurse include in this clients teaching to prevent injury?
Use a bath thermometer to test the water temperature.
The laboratory results of a client following chemotherapy for cancer indicate bone marrow suppression. The nurse should encourage the client to:
Use an electric razor when shaving
A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain?
Variant angina
An oxygen delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed?
Venturi mask
A 60-year-old client with a long history of cardiovascular problems, including angina and hypertension, is to have a cardiac catheterization. During precardiac catheterization teaching, the nurse explains to the client that the major purpose for this procedure is to:
Visualize the disease process in the coronary arteries
When obtaining the history of a 24 year old graduate student recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of:
WEIGHT LOSS
The nurse is teaching the client recently diagnosed with essential HTN. Which instruction should the nurse provide when discussing heart-healthy exercise?
Walk at least 30 mins a day on flat surfaces
A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? How should the nurse respond?
Your brain needs a constant supply of glucose because it cannot store it.
A nurse cares for a client who has a family history of diabetes mellitus. The client states, My father has type 1 diabetes mellitus. Will I develop this disease as well? How should the nurse respond?
Your risk of diabetes is higher than the general population, but it may not occur.
A client with type 2 diabetes mellitus is being discharged from the hospital after an occurrence of hyperglycemic hyperosmolar state (HHS). The nurse develops a discharge teaching plan for the client and identifies which as a priority?
monitoring for S&S of dehydration
A nurse is teaching a client who has recovered from an MI how to prevent an MI in the future. The nurse evaluates that further teaching is needed when the client states, "I will:
restrict my physical activity."
A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this clients teaching to prevent blood borne infections?
Do not share your monitoring equipment.
A preoperative nurse assesses a client who has type 1 diabetes mellitus prior to a surgical procedure. The clients blood glucose level is 160 mg/dL. Which action should the nurse take?
Document the finding in the clients chart.
The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate?
Document the findings
A client undergoes an abdominal cholecystectomy with common duct exploration. In the immediate postoperative period the nursing action that is the priority for this client is:
ENCOURAGING COUGHING AND DEEP BREATHING
A child admitted to the hospital with a diagnosis of status asthmaticus appears to be improving. What is the most objective way for the nurse to evaluate the child's response to therapy?
EVALUATE PEAK EXPIRATORY FLOW RATE
The nurse is reviewing a client's record and notes that the HCP has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which of the following?
Elevated creatinine level
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?
Elevating the affected arm on a pillow above her heart level
A nurse assesses a client who has a 15-year history of diabetes and notes decreased tactile sensation in both feet. Which action should the nurse take first?
Examine the clients feet for signs of injury.
A client tells the nurse that his total cholesterol level is 240. Which action should the nurse implement?
Explain that the client needs to lower the level
What signs and symptoms would the nurse expect to observe in a patient with excessive white blood cells present in the urine?
Fever and chills
You are preparing to review a teaching plan for a patient with type 2 diabetes mellitus. To determine the patient's level of compliance with his prescribed diabetic regimen, which value would you be sure to review?
GLYCOSYLATED HEMOGLOBIN (HGB A1C) LEVEL
Sulfonylureas
Glipizide (Glucotrol) Glimepiride (Amaryl) Glyburide ↑ insulin production from pancreas ↓ chance of prolonged hypoglycemia 10% of patients experience decreased effectiveness after prolonged use.
Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. The nurse should:
HAVE THE CLIENT DRINK A GLASS OF MILK OR ORANGE JUICE.
A client with chronic kidney disease is receiving Epogen. Which laboratory result would indicate a therapeutic effect of the medication?
Hematocrit of 32%
The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer?
Hematuria
A client tells the nurse, "I don't have any family members with hypertension so I don't have to worry about that." The nurse should educate the client on which of the following other risk factors?
High sodium diet, Physical inactivity, Stress
A client is diagnosed as having type 2 diabetes. A priority teaching goal is, "The client will be able to:
IDENTIFY PENDING HYPOGLYCEMIA OR HYPERGLYCEMIA."
A client with bronchial pneumonia is having difficulty maintaining airway clearance because of retained secretions. Which intervention will help decrease retained secretions?
INCREASING FLUID INTAKE TO AT LEAST TWO LITERS A DAY
To help reduce a client's risk factors for heart disease, the nurse, when discussing dietary guidelines, teaches the client to:
Increase the quantity of complex carbohydrates
A hospitalized client complains of chest pain that feels like a pressure or weight on the chests. The client also states, "I feel nauseated and very weak." The nurse should:
Initiate a rapid response code
The client diagnosed with a DVT is placed on a medical unit. Which nursing interventions should be implemented? (SATA)
Instruct client to stay in bed and not ambulate, Encourage fluids and a diet high in roughage (fiber), Monitor IV site q4h and prn
You are developing a standardized care plan for the postoperative care of clients undergoing cardiac surgery. Which nursing activity included in the care plan will need to be performed by RN staff members?
DEVELOPING AND INDIVIDUAL PLAN FOR DISCHARGE TEACHING BASED ON DISCHARGE MEDICATIONS AND NEEDED LIFESTYLE CHANGES
A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular heart block. The nurse should assess the client for signs of:
DIGOXIN TOXICITY
A female client who has recurrent urinary tract infections is inquiring about the prevention of future UTIs. What information should the nurse include when teaching the client? (Select all that apply).
DRINK 8-10 GLASSES OF WATER EACH DAY, URINATE IMMEDIATELY AFTER SEXUAL INTERCOURSE
The nurse should assess the client with left-sided heart failure for which findings? (Select all that apply)
DYSPNEA, CRACKLES, OLIGURIA, DECREASED OXYGEN SATURATION LEVELS
After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations?
Diabetes can cause blindness, so I should see the ophthalmologist yearly.
Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client?
Diabetes mellitus