PrepU exam 1
On admission to the inpatient psychiatric unit, a clients facial expression indicates severe panic. What is the nurse's best response to initiate a therapeutic relationship with the client?
"Hello, my name is _____. I am a nurse, and I'll care for you when I'm on duty. Should I call you _____, or do you prefer something else?"
A child is diagnosed with chronic otitis media. Which statement by the mother indicates an understanding of this condition?
"I'll tell my relatives they can't smoke around the baby."
Which statement by the parent of a child being treated for pinworms indicates that further teaching is needed?
"I'll warn my child to avoid sharing hairbrushes and hats to prevent spreading pinworms to others." This would reduce the spread of lice, not pinworms.
A 1-year-old infant is pale with a hematocrit of 24%. Which question by the nurse to the parents would be most useful in helping to establish a diagnosis of anemia?
What's the infant's usual daily diet?
A client recovers from an episode of acute pulmonary edema and is prescribed enalapril. What does the nurse determine is the most important outcome of administration of this medication?
Enalapril is an ACE inhibitor that reduces blood pressure and decreases the workload of the heart.
Which medication does a nurse expect the physician to order to treat legionnaires disease?
Erythromycin is the drug of choice for treating legionnaires disease.
A client with idiopathic seizure disorder is being discharged with a prescription for phenytoin. Client teaching about this drug should include which instruction?
"Schedule followup visits with your physician for blood tests."
Which statement regarding acute glomerulonephritis indicates that the parents of a child with this diagnosis understand the education provided by the nurse?
"This disease occurs after a streptococcal infection."
Acetylcysteine must be used cautiously in a client with asthma because:
Acetylcysteine is a mucolytic agent that decreases the viscosity of respiratory secretions and may induce bronchospasm.
An adolescent who is depressed and whose parents report as having difficulty in school is brought to the community mental health center to be evaluated. Which additional problem would the nurse expect the client to have?
Adolescents with depression tend to demonstrate severe irritability and behavioral problems.
A client with Cushing syndrome is upset about the physical appearance and body changes that have occurred. What is the nurse's best response?
As the syndrome is treated, the physical changes will go away.
A client with schizophrenia has been taking haloperidol for one week and is now experiencing jerking movements of the neck and mouth. The nurse suspects that the client may be experiencing which condition?
Dystonia is marked by prolonged, repetitive muscle contractions that cause twisting or jerking movements, especially of the neck, mouth, and tongue.
The nurse is caring for a client with a ventricular septal repair receiving dopamine postoperatively. Which physical response in the client indicates a therapeutic effect of the medication?
Increased cardiac output
The nurse is reinforcing education for a client about nutrition and lithium medication. The nurse instructs the client that a lack of dietary salt intake can have which effect on lithium levels?
Lithium plasma levels increase when there is a decrease in dietary salt.
A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms?
Numbness, tingling, and muscle twitching and spasms are symptoms of hypocalcemia.
A client with seizure disorder comes in for a routine checkup. Knowing that the client takes phenytoin to control seizures, the nurse assesses for which common adverse drug reaction?
Phenytoin can lead to excessive gum tissue growth.
A client is admitted to a semiprivate room on a medical surgical unit. Which nursing actions our best to maintain the privacy of client information? Select all that apply.
Pull the curtains when interviewing the client, speak in a low tone if there is another client in the room, take the client to a private room for admission interview.
What is the most important postoperative instructions the nurse must give a client who has just returned from the operating room after receiving a subarachnoid block?
Remain supine for the time specified by the physician.
A client with chronic renal failure is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience what?
The client probably will experience weight loss, because hemodialysis removes retained fluid.
The plan of care for a client with anorexia nervosa includes the parents of the client in therapy sessions alongside their child. Which fact would be most important to incorporate about the parents when implementing this plan?
The parents of such clients have a tendency to overprotect their children.
