Chapter 2, 7, 19 & 20

The nurse is caring for a client with Paget's disease who has an elevated serum calcium level of 12.3 mEq/L. The nurse checks to see that which medication is available in the stock medication supply area for possible use to reverse this elevation?

Calcitonin (Calcimar)

A client with a history of simple partial seizures is taking clorazepate (Tranxene), and asks the nurse if there is a risk of addiction. The nurse's response is based on which fact?

Clorazepate leads to physical and psychological dependence with prolonged high-dose therapy.

The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement, if made by one of the parents, indicates an understanding of the use of the harness?

I can remove the harness to bathe my infant

The nursing student is developing a plan of care for the hospitalized client with bulimia nervosa. The nursing instructor intervenes if the student documents which incorrect intervention in the plan?

Observe for excessive exercise

In planning care for a child with contact dermatitis, which concern is the highest priority for the child?

Pain

The nurse should anticipate that which medication is the most likely to be prescribed prophylactically for a child with spina bifida (myelomeningocele) who has a neurogenic bladder

Sulfisoxazole

The nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that which is a characteristic of this type of nursing model of practice?

Nursing staff are led by the nurse when providing care to a group of clients.

A 1-year-old child is seen in the health care provider's office with complaints of an elevated temperature that began the previous evening. When gathering subjective data from the mother, the nurse notices that which sign/symptom would most likely indicate the child has acute otitis media

The mother states the child had purulent discharge from the ear last night.

The nursing instructor asks a nursing student about phenylketonuria (PKU). Which statement made by the student indicates an understanding of this disorder?

All 50 states require routine screening of all newborns for PKU

A client with portosystemic encephalopathy is receiving oral lactulose daily. The nurse should check which to determine medication effectiveness?

Blood ammonia levels

The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle attached to a syringe containing a clear liquid into the antecubital area. Which action would be the appropriate initial action by the nurse?

Call the nursing supervisor

The nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action?

Decline to sign the will

The nurse reviews the activity schedule for the day and determines that the best supervised activity that the manic client could participate in is which?

Ping Pong

The nurse is reinforcing instructions regarding the prevention of Lyme disease to a group of teenagers going on a hike in a wooded area. Which points should the nurse include in the session? Select all that apply

Tuck pant legs into socks. Wear closed shoes when hiking. Apply insect repellent containing DEET. Cover the ground with a blanket when sitting.

A client experiences a cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style?

Autocratic

The nurse notes that a client is taking lansoprazole (Prevacid). On data collection the nurse asks which question to determine medication effectiveness?

Are you experiencing any heartburn

Emergency surgery is scheduled for a client with a bowel obstruction. The licensed practical nurse (LPN) tells the registered nurse (RN) that she is unable to obtain informed consent from the client because the client has received opioid analgesics and is sedated. The LPN understands that which action should be implemented

Obtaining a telephone consent from the family member and ensuring that the oral consent is witnessed by two persons