A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, “I’m just not feeling right.” What is the priority question the nurse should ask this client?

Amount of fluid intake.

Timing of medication administration.

Previous effectiveness of laxatives.

The amount of fiber intake.

Answer and Explanation

The Correct Answer is A

The nurse should ask this question because the client is taking a chemical stimulant laxative, which can cause dehydration and electrolyte imbalance, especially in combination with medications for heart failure and osteoarthritis that may also affect fluid and electrolyte balance. The nurse should assess the client’s hydration status and risk of hypovolemia or hypotension.

Choice B. Timing of medication administration is wrong because it is not the priority question in this situation.

The nurse should ask this question later to determine if the client is taking the medications as prescribed and if there are any drug interactions or adverse effects.

Choice C. Previous effectiveness of laxatives is wrong because it is not relevant to the client’s current condition.

The nurse should ask this question later to evaluate the client’s bowel habits and history of constipation.

Choice D. The amount of fiber intake is wrong because it is not the priority question in this situation.

The nurse should ask this question later to educate the client about dietary measures to prevent constipation and promote bowel health.

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Correct Answer is C

Explanation

A. A 12-year-old child with obsessive-compulsive disorder is not typically a candidate for misoprostol, as it is not indicated for this condition.

B. A 46-year-old trial lawyer with hypertension might need caution when using misoprostol, as it can cause diarrhea and abdominal pain, which could be problematic.

C. An 83-year-old client with rheumatoid arthritis is the best candidate for misoprostol, particularly if they are taking nonsteroidal anti-inflammatory drugs (NSAIDs) for their condition. Misoprostol is often used to prevent NSAID-induced gastric ulcers in patients at high risk, such as elderly individuals or those with a history of ulcers.

D. A 22-year-old pregnant client should not be given misoprostol unless it is used for specific obstetric indications under close supervision. Misoprostol can induce uterine contractions and is contraindicated in pregnancy unless used for medical reasons like inducing labor or treating postpartum hemorrhage.

A. Number of times client’s family reports the client is nauseated. B. How well the client is eating. C. Color and amount of vomit, and frequency of vomiting episodes. D. Client’s nutritional status and fluid balance.

Correct Answer is C

Explanation

The nurse would assess these factors to determine the need for therapy. Some possible explanations for the other choices are:

Choice A. Number of times client’s family reports the client is nauseated.

This is not a reliable indicator of the severity or cause of nausea and vomiting.

The nurse should assess the client directly and not rely on the family’s reports.

Choice B. How well the client is eating.

This is not a specific or objective measure of nausea and vomiting.

The client may have other reasons for not eating well, such as loss of appetite, taste changes, or pain.

The nurse should also monitor the client’s weight, hydration status, and electrolyte levels.

Choice D. Client’s nutritional status and fluid balance.

These are important aspects of the client’s overall health, but they are not directly related to nausea and vomiting.

The nurse should assess these factors as part of the comprehensive care plan, but they are not sufficient to determine the need for therapy.

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A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, “I’m just not feeling right.” What is the priority question the nurse should ask this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of these clients would the nurse expect to be the best candidate for misoprostol?

Correct Answer is C

Explanation

A client has begun reporting nausea and vomiting. What would the nurse assess to determine the need for therapy?

Correct Answer is C

Explanation

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