A patient with small cell carcinoma of the lung is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). The patient’s serum sodium level increases from 120 mEq/L to 125 mEq/L as they respond to treatment. Based on this finding, what intervention should the nurse implement?

Maintain the prescribed fluid restriction.

Withhold the next scheduled dose of treatment.

Increase neurologic checks to every 2 hours.

Assess for increasing fluid volume overload.

Answer and Explanation

The Correct Answer is A

Choice A rationale
Maintaining the prescribed fluid restriction is crucial in the management of SIADH. Fluid restriction helps to prevent further dilution of sodium in the blood, which can exacerbate the symptoms of SIADH34.
Choice B rationale
Withholding the next scheduled dose of treatment is not necessarily the appropriate intervention based on the increase in serum sodium level. The treatment plan should be adjusted based on the patient’s overall clinical picture and in consultation with the healthcare provider.
Choice C rationale
Increasing neurologic checks to every 2 hours is not directly related to the increase in serum sodium level. While neurologic checks are important in monitoring the overall health status of the patient, they are not specifically indicated based on the serum sodium level alone.
Choice D rationale
Assessing for increasing fluid volume overload is not the appropriate intervention based on the increase in serum sodium level. SIADH is characterized by water retention, not fluid volume overload.

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Correct Answer is A

Explanation

Choice A rationale
Auscultating a bruit over the graft area of a client who has an arteriovenous (AV) graft in the right forearm for hemodialysis access is a normal finding. A bruit is a vibration felt over the graft that indicates blood flow. Therefore, the nurse should document the findings as it indicates the graft is patent and functioning properly.
Choice B rationale
Elevating the extremity is not necessary in this case. The presence of a bruit indicates that the graft is functioning properly.
Choice C rationale
Applying gentle pressure is not the appropriate intervention in this case. The presence of a bruit is a positive sign indicating the graft is functioning properly.
Choice D rationale
Assessing the client’s temperature is not directly related to the presence of a bruit over the graft area. The temperature would not provide information about the patency or function of the AV graft.

A. Antibiotics take two weeks to become effective against infections such as athlete’s foot. B. Continue using the ointment for a full week, even after the symptoms disappear. C. Applying too much ointment can deter its effectiveness. Apply a thin layer to prevent maceration. D. Stop using the ointment and encourage complete drying of feet and wearing clean socks.

Correct Answer is D

Explanation

Choice A rationale
Antibiotics are typically used to treat bacterial infections, not fungal infections like athlete’s foot. Therefore, using antibiotics would not be effective in this case.
Choice B rationale
While it’s important to use treatments for the full recommended duration to ensure the infection is completely eradicated, using an antibiotic ointment for a fungal infection like athlete’s foot would not be effective.
Choice C rationale
While it’s true that applying too much ointment can deter its effectiveness, the main issue here is that an antibiotic ointment is not the correct treatment for a fungal infection like athlete’s foot.
Choice D rationale
Athlete’s foot is a fungal infection that thrives in warm, moist environments. Therefore, keeping the feet dry and clean is an important part of managing and preventing athlete’s foot. This includes wearing clean socks and allowing the feet to dry completely before putting on shoes.

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A patient with small cell carcinoma of the lung is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). The patient’s serum sodium level increases from 120 mEq/L to 125 mEq/L as they respond to treatment. Based on this finding, what intervention should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has an arteriovenous (AV) graft in the right forearm for hemodialysis access. The nurse auscultates a bruit over the graft area. Which intervention should the nurse implement?

Correct Answer is A

Explanation

The parent of an adolescent tells the clinic nurse, “My child has athlete’s foot. I have been applying triple antibiotic ointment for two days, but there has been no improvement.”. Which instruction should the nurse provide?

Correct Answer is D

Explanation

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