When admitting a client with a diagnosis of transient ischemic attack (TIA), which intervention is most important for the nurse to include in this client's plan of care?

Assess bilateral breath sounds.

Palpate the suprapubic region for urinary retention.

Review the client's daily medications.

Initiate neurological monitoring every 2 hours.

Answer and Explanation

The Correct Answer is D

Choice A reason: While assessing breath sounds is part of a comprehensive evaluation, it is not the most critical intervention for a TIA, which primarily affects neurological function.

Choice B reason: Palpating the suprapubic region for urinary retention is important but not the priority intervention for a client with TIA, as it does not directly relate to the risk of stroke.

Choice C reason: Reviewing the client's daily medications is necessary for overall care but is not the most immediate concern upon admission for a TIA.

Choice D reason: Initiating neurological monitoring every 2 hours is essential for a client with TIA to promptly identify any changes or progression in neurological status, which could indicate a stroke. This is the most important intervention to include in the plan of care for a client admitted with TIA. Neurological monitoring allows for immediate intervention if the client's condition worsens, potentially preventing further ischemic damage.

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Correct Answer is C

Explanation

Choice A reason: While pneumatic compression devices are used for DVT prevention, they are not the immediate intervention for suspected stroke.

Choice B reason: Placing an indwelling urinary catheter is not the first-line intervention for a patient with suspected stroke symptoms.

Choice C reason: Notifying the stroke team is the most appropriate action as the patient's symptoms suggest a possible stroke, requiring urgent evaluation and management.

Choice D reason: Aspirin may be used in the management of stroke, but only after a stroke has been confirmed and not as an immediate intervention.

Correct Answer is ["2"]

Explanation

Step 1: We need to find out how many mL contain 10 mg of loratadine. Since 5 mg of loratadine is in 5 mL, we can set up a proportion to find out how many mL contain 10 mg.

So, 5 mg is to 5 mL as 10 mg is to X mL.

This gives us the equation: (5 mg ÷ 5 mL) = (10 mg ÷ X mL)

Step 2: Solving for X gives us X = (10 mg × 5 mL) ÷ 5 mg

Step 3: Simplifying gives us X = 10 mL

So, the client needs to take 10 mL of the loratadine suspension to get a dose of 10 mg.

Now, we need to convert this volume in mL to teaspoons, using the conversion factor you provided (1 teaspoon = 5 mL).

Step 4: We set up the conversion as follows: 10 mL × (1 tsp ÷ 5 mL)

Step 5: Simplifying gives us 2 tsp

So, the nurse should instruct the client to take 2 teaspoons of the loratadine suspension.

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When admitting a client with a diagnosis of transient ischemic attack (TIA), which intervention is most important for the nurse to include in this client's plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A client has received a prescription for loratadine suspension, 10 mg to be taken orally once a day. The bottle is labeled as "Loratadine for Oral Suspension, USP 5 mg per 5 mL." How many teaspoons should the nurse instruct the client to take? (Please enter the numerical value only.)

Correct Answer is ["2"]

Explanation

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