A nurse in a clinic is caring for an older adult client.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Digoxin Toxicity: The client’s symptoms (nausea, vomiting, diarrhea, weakness), vital signs (bradycardia), and lab results (high digoxin level, low potassium and magnesium) suggest digoxin toxicity.

Cardiac Monitor: To detect any arrhythmias resulting from digoxin toxicity.

Icterus: To assess liver function, which could be impacted in severe toxicity.

Electrolytes: Imbalances in potassium and magnesium can worsen digoxin toxicity and need to be corrected.

Fever: The fever might indicate an infection or inflammatory process, which can affect treatment and recovery.

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Correct Answer is D

Explanation

A. Increasing the rate to 250 mL/hr is not appropriate as it could lead to fluid overload or worsen the client’s condition.

B. Slowing the rate to 20 mL/hr may be too low for maintaining adequate hydration or treatment needs in the context of a head injury.

C. Slowing the rate to 50 mL/hr is not indicated unless there is a specific reason to decrease the fluid rate based on clinical conditions, which is not stated here.

D. Continuing the rate at 125 mL/hr is appropriate for maintaining the current IV fluid regimen unless there are specific orders or conditions that require a change.

A. Engage in repetitive tasks, even when joints are inflamed, to keep the joints mobile. B. Press water from a sponge rather than wringing it. C. Finish weekly household tasks within 1 or 2 days. D. Turn doorknobs using a clockwise motion.

Correct Answer is B

Explanation

A. Engage in repetitive tasks, even when joints are inflamed, to keep the joints mobile is not recommended; rest and joint protection are important during inflammation.

B. Press water from a sponge rather than wringing it is a good strategy to avoid straining the joints.

C. Finish weekly household tasks within 1 or 2 days may lead to increased stress on the joints; tasks should be spread out to avoid exacerbating symptoms.

D. Turn doorknobs using a clockwise motion does not have specific benefits for managing rheumatoid arthritis; using adaptive devices is generally recommended.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is caring for a client who sustained a head injury. The nurse notes the client's IV fluids are infusing at 125 mL/hr. Which of the following is an appropriate action by the nurse?

Correct Answer is D

Explanation

A nurse is teaching a client who has rheumatoid arthritis about self-care strategies for managing the disease. Which of the following activities should the nurse include in the teaching?

Correct Answer is B

Explanation

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include in the evaluation of the neurovascular status of the client's affected extremity? (Select all that apply.)

A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan of care?

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

A nurse is caring for a client. Exhibits Click to specify if the client statements indicate understanding or no understanding.

A nurse is teaching a client who has gout about dietary recommendations. The nurse should teach the client that which of the following beverages can trigger an attack?

A nurse is reviewing the medication history of a client who has a new prescription for colchicine. Which of the following medications increases the client's risk when used in combination with colchicine for developing rhabdomyolysis?