The nurse is completing the admission assessment of a client with multiple sclerosis (MS). Which finding(s) should be reported to the healthcare provider immediately? Select all that apply.

Tinnitus.

Tachycardia.

Tremors.

Paresthesia.

Fever.

Answer and Explanation

Correct Answer : B,E

Choice A reason: Tinnitus is not an immediate concern in the context of multiple sclerosis.

Choice B reason: Tachycardia should be reported immediately as it could indicate an underlying cardiovascular issue or autonomic dysfunction.

Choice C reason: Tremors are a common symptom of multiple sclerosis and do not require immediate reporting unless there is a significant change.

Choice D reason: Paresthesia is also a common symptom of multiple sclerosis and does not require immediate reporting unless there is a significant change.

Choice E reason: Fever should be reported immediately as it can indicate an infection, which can exacerbate multiple sclerosis symptoms.

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Correct Answer is A

Explanation

Choice A reason: Starting with less sensitive questions helps build rapport and makes the client feel more comfortable before addressing more sensitive topics such as domestic violence.

Choice B reason: Getting the most difficult questions over with first can make the client feel uncomfortable and defensive, potentially hindering the interview process.

Choice C reason: Sharing personal values is not appropriate and can bias the interview, making the client less likely to open up.

Choice D reason: Asking vague, nonspecific questions does not help gather the necessary information effectively and may confuse the client.

Correct Answer is ["121"]

Explanation

Calculation Steps:

Step 1: Convert weight from pounds to kilograms: 160 pounds ÷ 2.2 = 72.7 kg. Result = 72.7 kg.

Step 2: Calculate the total daily dose: 5 mg/kg/day × 72.7 kg = 363.5 mg/day. Result = 363.5 mg/day.

Step 3: Calculate the dose per administration: 363.5 mg/day ÷ 3 doses/day = 121.2 mg/dose. Result = 121.2 mg/dose.

Step 4: Round to the nearest whole number: 121.2 mg ≈ 121 mg.

Result = 121 mg.

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The nurse is completing the admission assessment of a client with multiple sclerosis (MS). Which finding(s) should be reported to the healthcare provider immediately? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client presents to the emergency department (ED) reporting abdominal pain. The nurse observes the client's right cheek and eye are bruised and suspects possible domestic violence. Which approach is best for the nurse to use when interviewing the client?

Correct Answer is A

Explanation

A client who weighs 160 pounds receives a prescription for gentamicin 5 mg/kg/day IV in divided doses every 8 hours. How many mg should the nurse administer with each dose? (Enter numerical value only. If rounding is required, round to the nearest whole number.)

Correct Answer is ["121"]

Explanation

A client is being treated for syndrome of inappropriate antidiuretic hormone (SIADH). On examination, the client has a weight gain of 4.4 lbs (2 kg) in 24 hours and an elevated blood pressure. Which intervention should the nurse implement first?

A client with limited tolerance for activity needs to walk in the hallway with assistance. Which instruction(s) should the nurse give to the unlicensed assistive personnel (UAP) who is assisting with the client's care? Select all that apply.

A client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant heart sounds, and is anxious and restless. After initiating oxygen therapy and IV hydration, which intervention is most important for the nurse to implement?

Which client is best to assign to the practical nurse (PN) who is assisting the registered nurse (RN) with the care of a group of clients?

The nurse is completing the admission assessment of a client with multiple sclerosis (MS). Which finding(s) should be reported to the healthcare provider immediately? Select all that apply.

During an admission assessment, a client reports currently using heroin. Which information is most important for the nurse to consider in the plan of care?