br>History and Physical

BP 100/60 mm Hg Pulse 52/min
Respiratory rate 20/min

Temperature 37.2" C (99.0° F)

A nurse is caring for an adolescent who is receiving treatment for heart failure. Based on the

client's chart findings, which of the following actions should the nurse plan to take? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Administer furosemide.

Withhold digoxin.

Withhold spironolactone.

Administer ferrous sulfate.

Answer and Explanation

The Correct Answer is B

A. Administering furosemide may also be appropriate for managing heart failure symptoms, but the priority action based on the client's condition is to withhold digoxin.

B. The client's vital signs indicate bradycardia (pulse 52/min), which is a common adverse effect of digoxin, especially in the setting of heart failure. Withholding digoxin is necessary to prevent further exacerbation of bradycardia and potential toxicity.

C. Withholding spironolactone may be considered if there are concerns about electrolyte imbalances, but it is not the priority action in this scenario.

D. Administering ferrous sulfate is not indicated based on the client's chart findings; there is no indication of anemia or iron deficiency.

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Correct Answer is C

Explanation

A. Compulsive attention to details: This behavior is more characteristic of obsessive-compulsive personality disorder rather than antisocial personality disorder.

B. Avoids interacting with others: Antisocial personality disorder is characterized by a disregard for and violation of the rights of others, but avoidance of social interaction is not a typical

feature.

C. Uses others for personal gain: This behavior aligns with the manipulative and exploitative tendencies often seen in individuals with antisocial personality disorder.

D. Socially awkward in group situations: While individuals with antisocial personality disorder may have difficulty forming meaningful relationships, they often have superficial charm and can be socially adept, so being socially awkward in group situations is less indicative of this disorder.

A. Metoprolol B. Clopidogrel C. Metformin D. Digoxin

Correct Answer is C

Explanation

A. Metoprolol is a beta-blocker used to treat hypertension and other cardiovascular conditions.

While it may be important for the provider to be aware of all medications, it is not the priority to report in this scenario.

B. Clopidogrel is an antiplatelet medication used to prevent blood clots in individuals at risk for cardiovascular events. While it may have implications for the procedure, it is not the priority to report in this scenario.

C. Metformin is an oral antidiabetic medication commonly used to treat type 2 diabetes. It is

important to report because there may be specific considerations regarding its use in the context of a colonoscopy, such as the risk of lactic acidosis.

D. Digoxin is a medication used to treat heart failure and certain arrhythmias. While it may have implications for the procedure, it is not the priority to report in this scenario.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has antisocial personality disorder. Which of the following client behaviors should the nurse identify as consistent with this disorder?

Correct Answer is C

Explanation

A nurse is performing an admission assessment for a client who is to undergo a colonoscopy. The client informs the nurse that he took his prescribed medications before coming to the clinic. Which of the following medications is the priority to report to the provider?

Correct Answer is C

Explanation

A nurse is teaching the parent of a school-age child who has scabies about the application of permethrin 5% cream. The nurse should include which of the following as a potential adverse effect of the medication?

A nurse is planning care for a client following gastric bypass surgery. The nurse should include which of the following dietary instructions when preparing the client for discharge?

A nurse is planning care for a client who is experiencing acute mania. Which of the following actions should the nurse include in the plan of care?

A nurse is caring for a client who experienced a stroke and has dysphagia. Which of the following findings should indicate to the nurse the client is at risk for aspiration?

A nurse is caring for a client who has a hearing impairment. When speaking to the client, the nurse should incorporate which of the following communication methods?

A nurse is planning care for a child who has increased intracranial pressure with a decrease in the level of consciousness. Which of the following interventions should the nurse include inthe plan of care?

A nurse in a substance use unit spends an equal amount of time with each of his assigned clients, even though some of the clients have committed serious crimes. Which of the following ethical principles is the nurse demonstrating?