You're providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points?

"I will weigh myself daily and report to my physician if I gain more than 3 lbs in 1 day."

"This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day."

"I will eat a diet rich in potatoes, bananas, avocadoes, strawberries, and spinach."

"I will change position slowly because I can become dizzy easily while taking this medication."

Answer and Explanation

The Correct Answer is C

Loop diuretics, such as furosemide, are known to promote diuresis (increased urine output) and can cause electrolyte imbalances, including low potassium (hypokalemia). The patient's statement about eating a diet rich in potassium-containing foods like potatoes, bananas, avocadoes, strawberries, and spinach is incorrect in this context. These foods are indeed good sources of potassium, but when taking loop diuretics, it is necessary to monitor and potentially restrict potassium intake to prevent excessive potassium levels.

"I will weigh myself daily and report to my physician if I gain more than 3 lbs in 1 day." This statement reflects the patient's understanding of the need to monitor their weight daily as a means of assessing fluid balance. Rapid weight gain may indicate fluid retention, which should be reported to the physician.

"This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day." This statement demonstrates awareness of the potential for dehydration when taking loop diuretics and the importance of staying adequately hydrated by consuming an appropriate amount of fluids.

"I will change position slowly because I can become dizzy easily while taking this medication." This statement reflects the understanding that loop diuretics can cause orthostatic hypotension,

leading to dizziness upon sudden changes in position. Taking precautions and changing position slowly can help prevent falls and related injuries.

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Correct Answer is ["A","D","E"]

Explanation

The teaching that the nurse will provide to the Patient Care Technician (PCT) when delegating ambulation for a client includes:

● "Please let me know how the client does after each ambulation": This instruction ensures that the PCT communicates any relevant information or changes observed during or after the ambulation, allowing the nurse to stay informed about the client's condition.

● "Be certain to use a gait belt when performing this activity": Using a gait belt is an important safety measure during ambulation. It helps provide support and stability for the client and allows the PCT to maintain control and assist in case the client becomes unsteady or falls.

● "Each ambulation should last 10 minutes": Providing a specific time frame for the ambulation helps guide the PCT in determining the duration of the activity. This ensures consistency in the care provided and allows for proper scheduling of ambulation throughout the day.

The other options provided ("Ambulate the client every four hours," "Come and get me for lunch") do not pertain to specific instructions or teaching related to the delegated ambulation task. The frequency of ambulation and the PCT's lunch break are not relevant to the teaching for this specific task.

A. Bleeding posterior to the nasal packing. B. Oral dryness caused by nasal packing. C. An adverse reaction to the analgesic. D. A normal response to the analgesic and surgery.

Correct Answer is B

Explanation

Rhinoplasty is a surgical procedure performed on the nose, and it often involves the placement of nasal packing to control bleeding, support the nasal structures, and promote healing. Nasal packing can cause mouth breathing and oral dryness, which can lead to increased swallowing as the patient tries to alleviate the discomfort.

While bleeding posterior to the nasal packing is a potential complication of rhinoplasty, it typically presents with other symptoms such as active bleeding, nasal discharge, or changes in vital signs. Without additional information or signs of active bleeding, it is less likely to be the cause of the patient's frequent swallowing in this scenario.

An adverse reaction to the analgesic is possible, but it would typically present with other symptoms such as allergic reactions (rash, swelling, difficulty breathing) or gastrointestinal symptoms (nausea, vomiting). In the absence of these symptoms, an adverse reaction to the analgesic is less likely.

Lastly, a normal response to the analgesic and surgery would not typically manifest as frequent swallowing. While pain medication can cause side effects, such as drowsiness or nausea, increased swallowing is not a common response.

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You're providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is delegating ambulation for a client to an experienced Patient Care Technician (PCT).Which teaching will the nurse provide to the PCT? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

A patient, age 23, underwent a rhinoplasty 6 hours ago. After administering his pain medication, the nurse notes that he is swallowing frequently. What is the most likely cause of the swallowing?

Correct Answer is B

Explanation

A nurse is performing a musculoskeletal assessment on an older adult. What normal Physiological changes of aging does the nurse expect?

The nurse is caring for a client on a ventilator from complications of pneumonia. The nurse observes the low-pressure ventilator alarm and a pulse oximetry reading of 85%. What should be the nurse's first action?

Match using the choices provided:

In reviewing the electrolytes of a patient, the nurse notes the serum potassium level has increased from 4.3 mEq/L to 5.9 mEq/L. Which assessment does the nurse initiate first to prevent further harm?

After receiving a hand-off report what assessment information is the most important and immediate concern for the nurse? Select all that apply.

A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the best action by the nurse?

The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease lower esophageal sphincter (LES) pressure. What should be included in this list (select all that apply)?