An adult is admitted with acute flank pain, a 102°F (38.9°C) oral temperature, hematuria, dysuria, urgency, and fishy-smelling urine. Which admitting prescription(s) are most important for the nurse to implement? Select all that apply.

Obtain clean catch urine for culture and sensitivity.

Initiate broad spectrum IV antibiotic as secondary infusion.

Collect a serum sample for hemoglobin and hematocrit.

Give diphenhydramine prep for intravenous pyelogram.

Force oral fluids to 2,000 mL/24 hours.

Answer and Explanation

Correct Answer : A,B

Choice A reason: Obtaining a clean catch urine sample for culture and sensitivity is crucial for identifying the specific bacteria causing the infection and determining the appropriate antibiotic treatment.

Choice B reason: Initiating broad spectrum IV antibiotics is important to start treating the infection immediately, especially given the severity of the symptoms.

Choice C reason: Collecting a serum sample for hemoglobin and hematocrit is not immediately necessary in this scenario. The focus should be on diagnosing and treating the infection.

Choice D reason: Giving diphenhydramine prep for intravenous pyelogram is not relevant to the immediate management of the client's condition.

Choice E reason: Forcing oral fluids can help flush out the urinary system, but it is not the most critical initial intervention compared to obtaining a urine culture and starting antibiotics.

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Correct Answer is B

Explanation

Choice A reason: Exenatide should be administered within 60 minutes before the morning and evening meals, not within 30 minutes before or after a meal.

Choice B reason: Notifying the healthcare provider if abdominal pain occurs is important because exenatide can cause pancreatitis, and abdominal pain may be a symptom of this condition.

Choice C reason: Exenatide does not act in the same way as insulin. It is an incretin mimetic that enhances glucose-dependent insulin secretion, among other actions.

Choice D reason: There are precautions when taking exenatide with other medications, especially those that affect blood glucose levels, so this statement is incorrect.

A. Obtain a 12-lead electrocardiogram daily. B. Evaluate glucose levels before and after meals. C. Monitor and document strict intake and output. D. Assess the serum potassium level every 4 hours.

Correct Answer is D

Explanation

Choice A reason: Obtaining a 12-lead electrocardiogram is important but not as frequent as monitoring potassium levels in this situation.

Choice B reason: Evaluating glucose levels is important but secondary to monitoring potassium levels.

Choice C reason: Monitoring and documenting intake and output are important but not as critical as frequent potassium level assessment.

Choice D reason: Frequent assessment of serum potassium levels is crucial due to the high initial potassium level and the use of insulin, which affects potassium levels.

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An adult is admitted with acute flank pain, a 102°F (38.9°C) oral temperature, hematuria, dysuria, urgency, and fishy-smelling urine. Which admitting prescription(s) are most important for the nurse to implement? Select all that apply.

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Naxlex Comprehensive Predictor Exams

The nurse is planning discharge instructions for a client with type 2 diabetes mellitus who will be starting exenatide. Which information should be included in the discharge instructions?

Correct Answer is B

Explanation

The healthcare provider prescribes a 5% dextrose injection with 20 units of regular insulin for a client with a serum potassium level of 6.0 mEq/L (6.0 mmol/L) and glucose level of 180 mg/dL (10.0 mmol/L). Which evaluation is most important for the nurse to include in this client's plan of care?

Correct Answer is D

Explanation

Which assessment technique provides the most useful data when the nurse is concerned about possible urinary retention?

The client who has emphysema and recently experienced a stroke receives a prescription for a metered-dose inhaler with a spacer device. The client asks the nurse if using the spacer is necessary. Which information should the nurse provide?

A client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant heart sounds, and is anxious and restless. After initiating oxygen therapy and IV hydration, which intervention is most important for the nurse to implement?

In caring for a client who is receiving linezolid IV for nosocomial pneumonia, which assessment finding is most important for the nurse to report to the healthcare provider?

A female client is taking alendronate, a bisphosphonate, for postmenopausal osteoporosis. The client tells the nurse that she is experiencing jaw pain. How should the nurse respond?