Exhibits
A nurse is reviewing the medical record of a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Dietary intake

Sore throat

Heart rate

Blood pressure

Answer and Explanation

The Correct Answer is B

Rationale:

A. Dietary intake: The client ate 75% of breakfast, which indicates adequate oral intake. While monitoring nutrition is important in schizophrenia, this finding does not pose an immediate safety concern or require urgent reporting.

B. Sore throat: A sore throat in a client taking clozapine is significant because clozapine can cause agranulocytosis, a potentially life-threatening reduction in white blood cells. Any signs of infection, such as sore throat or fever, must be reported immediately to prevent serious complications.

C. Heart rate: A heart rate of 98/min is slightly elevated but within acceptable limits for many adults. This finding alone does not indicate an urgent issue requiring immediate provider notification.

D. Blood pressure: A blood pressure of 102/56 mm Hg is slightly low but may be within the client’s normal range, particularly if the client experiences dizziness when changing positions. While it should be monitored, it does not require urgent reporting unless symptoms worsen.

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Correct Answer is C

Explanation

Rationale:

A. Naloxone: Naloxone is an opioid antagonist used to reverse opioid overdose. It does not provide pain relief and is not appropriate for managing acute exacerbations of chronic pain.

B. Acetaminophen: Acetaminophen is useful for mild to moderate pain but may be insufficient for an acute exacerbation of chronic pain, especially if the client has severe or breakthrough pain.

C. Fentanyl: Fentanyl is a potent opioid analgesic appropriate for managing severe acute pain or acute exacerbations of chronic pain. It acts rapidly to relieve pain and is often used in clients already tolerant to opioids.

D. Zolpidem: Zolpidem is a sedative-hypnotic used to treat insomnia. It does not have analgesic properties and is not indicated for pain management.

A. The client's frequency of incontinence has decreased. B. The client's iron level has increased. C. The client's high-density lipoprotein level has increased. D. The client's HbA1c has decreased.

Correct Answer is D

Explanation

Rationale:

A. The client's frequency of incontinence has decreased: Incontinence is not a direct measure of blood glucose control or the effectiveness of metformin. Changes in urinary frequency may be influenced by other conditions, such as urinary tract infections or prostate issues, and do not indicate the medication’s success.

B. The client's iron level has increased: Metformin does not affect iron metabolism. An increase in iron levels would be unrelated to metformin therapy and could reflect dietary changes, supplementation, or other underlying conditions.

C. The client's high-density lipoprotein level has increased: While metformin may have mild beneficial effects on lipid profiles, its primary purpose is to improve glycemic control. Changes in HDL are not the main indicator of therapeutic success for this medication.

D. The client's HbA1c has decreased: HbA1c reflects average blood glucose levels over the past 2–3 months. A decrease indicates improved glycemic control, which is the primary goal of metformin therapy. Monitoring HbA1c is the most reliable measure to evaluate the effectiveness of the medication.

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Body System	Findings
Neurological	Reports that dizziness and palpitations started 2 months ago. Alert and oriented to person, place, and time
Cardiovascular	Pedal pulses +1 bilaterally, Pedal edema +1 bilaterally. Capillary refill time 5 seconds for all extremities. Reports no pain with palpation of thorax.
Respiratory	Fatigue and dyspnea with exertion started 1 week ago. Lungs clear to auscultation bilaterally
Vital Signs	Heart rate 105/min Respiratory rate 20/min Blood pressure 164/92 mm Hg Oxygen saturation 96% on room air

Exhibits A nurse is reviewing the medical record of a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an acute exacerbation of chronic pain. Which of the following medications should the nurse anticipate administering for the client?

Correct Answer is C

Explanation

A nurse is caring for a client who was prescribed metformin 6 months ago. Which of the following findings indicates a positive response to the medication?

Correct Answer is D

Explanation

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Exhibits
A nurse is reviewing the medical record of a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)