History and Physical

The client is a 26-year-old female with acute appendicitis. She has a 12-year history of type 1 diabetes and no other significant medical histor The appendectomy was completed without issue, and the client will be admitted to the surgical floor to recover.

For each nursing action below, click to specify if the action is indicated, contraindicated or non-essential.

Verify that the client can count carbohydrates

Restart the IV fluids until the tray arrives

Give insulin lispro 4 units

Give insulin glargine 12 units

Mix the insulin lispro and insulin glargine in one syringe

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"C"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Choice A rationale: Indicated. This is important for a client with type 1 diabetes, as counting carbohydrates helps in calculating the appropriate insulin dose and maintaining glycemic control.

Choice B rationale: Non-essential. The client is already admitted to the surgical floor and does not require restarting the IV fluids unless there is a specific medical indication.

Choice C rationale: Contraindicated. Insulin doses should be prescribed by a healthcare provider based on the patient's blood glucose levels and individual insulin requirements. The nurse should follow the prescribed insulin orders and not administer insulin without an order.

Choice D rationale: Indicated. Insulin glargine is a long-acting basal insulin used to provide a steady background insulin level throughout the day. The nurse should administer the prescribed insulin glargine dose as ordered.

Choice E rationale: Contraindicated. Insulin lispro is a rapid-acting insulin, and insulin glargine is a long-acting insulin. Mixing different types of insulin in one syringe can alter their pharmacokinetics and lead to inconsistent blood glucose control. Insulin lispro and insulin glargine should be administered separately.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Indicated Instructions:

Hold spironolactone for 3 days (Choice D):
- Reasoning: Captopril, an ACE inhibitor, can increase potassium levels. Spironolactone is a potassium-sparing diuretic. Holding spironolactone helps prevent hyperkalemia (high potassium levels), which can be dangerous.
Lay down if the blood pressure drops quickly after the first dose (Choice E):
- Reasoning: Captopril can cause a significant drop in blood pressure, especially after the first dose. Lying down helps prevent dizziness and fainting (orthostatic hypotension) due to the sudden decrease in blood pressure.

Contraindicated Instructions:

Increase the lantus dose by 3 units the morning of the first dose (Choice B):
- Reasoning: Adjusting insulin (Lantus) dose is not related to the administration of captopril and could potentially cause blood sugar imbalances. Such a change should be based on blood glucose monitoring, not the initiation of captopril.
Limit fluids for several days before the first dose (Choice C):
- Reasoning: Limiting fluids can lead to dehydration, which can exacerbate the hypotensive effects of captopril. Maintaining adequate hydration is important to avoid severe drops in blood pressure.
Monitor blood pressure for several hours after the first dose (Choice B):
- Reasoning: Monitoring blood pressure ensures that any significant hypotensive response (drop in blood pressure) to the initial dose of captopril is identified and managed promptly.

A. Take with orange juice to enhance Gl absorption. B. Protect the skin from sunlight while taking the drug. C. Return to the clinic weekly to obtain serum drug levels. D. Take with milk or antacids to prevent gastrointestinal (GI) irritation.

Correct Answer is B

Explanation

Choice A rationale: Tetracycline should generally be taken on an empty stomach, as certain food and beverages, including orange juice, can interfere with its absorption. The nurse should instruct the client to take tetracycline with water and on an empty stomach unless otherwise specified by the healthcare provider.

Choice B rationale: Tetracycline is an antibiotic that can make the skin more sensitive to sunlight, leading to an increased risk of sunburn and photosensitivity reactions. To prevent these adverse effects, the nurse should instruct the client to protect their skin from sunlight while taking the medication. This includes using sunscreen, wearing protective clothing, and avoiding prolonged sun exposure. It is essential to educate the client about this potential side effect to ensure their safety and minimize skin reactions during treatment.

Choice C rationale: Tetracycline does not require routine monitoring of serum drug levels. It is an antibiotic with a well-established dosing regimen, and monitoring drug levels is not necessary for its safe and effective use.

Choice D rationale: While taking tetracycline with milk or antacids may help reduce GI irritation, it can also interfere with the absorption of the medication. Therefore, it is generally recommended to take tetracycline with water and on an empty stomach to ensure optimal absorption and effectiveness.

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Naxlex Comprehensive Predictor Exams

Exhibits For each instruction, click to indicate whether the instructions given by the nurse are indicated or contraindicated to prepare for the client's first dose of captopril.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

The healthcare provider prescribes the antibiotic tetracycline HCI for an adult client that arrived at an outpatient clinic. Which instruction should the nurse include in the teaching plan for this client?

Correct Answer is B

Explanation

A client on alcohol withdraw protocol suddenly begins to have a seizure in his bed. After several minutes the seizure has not ended and the nurse suspects the client is suffering from status epilepticus. What is the priority action the nurse will take?

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]

The nurse reviews the lab values. Exhibits What questions can the nurse ask the client based on the lab results? Select all that apply.

The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion?

A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?

A client receives a new prescription for levothyroxine. Which statement made by client indicates to the nurse the education was effective?