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Patient Data

Exhibits

What order(s) would the nurse question? (Select all that apply.)

Send blood for a complete blood count, electrolytes

Enalapril 10 mg every morning

C Ibuprofen 400 mg every 4 to 6 hours PRN for temperature greater than 100.5°F (38° C)

Admit to the medical floor

Supplemental oxygen 10 L/min via nasal cannula

Vital signs every 4 hours

Continuous pulse oximetry

Chest x-ray

Answer and Explanation

Correct Answer : C,E,H

A. Send blood for a complete blood count, electrolytes: This is appropriate for assessing the client's overall health status and electrolyte balance, which may be affected by pneumonia and enalapril therapy.

B. Enalapril 10 mg every morning: This is the client's maintenance dose of enalapril for managing hypertension, and it should be continued unless there are specific contraindications or concerns about renal function.

C. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase blood pressure and interfere with the antihypertensive effects of enalapril. Additionally, NSAIDs can potentially worsen renal function, which may already be compromised in a client with pneumonia.
D. Admit to the medical floor: This is appropriate for a client with pneumonia who may require close monitoring and management of respiratory status and other complications.
E. Supplemental oxygen 10 L/min via nasal cannula: High-flow oxygen can decrease respiratory drive and potentially worsen ventilation-perfusion (V/Q) matching, especially in clients with pneumonia.

F. Vital signs every 4 hours: Regular monitoring of vital signs is essential for assessing the client's response to treatment and identifying any signs of deterioration.

G. Continuous pulse oximetry: Continuous pulse oximetry provides real-time monitoring of oxygen saturation and helps assess the effectiveness of oxygen therapy and the client's respiratory status.

H. While a chest x-ray is often indicated for diagnosing pneumonia, ordering it "now" may not be necessary unless the client's condition is unstable or if there are specific concerns regarding the severity of the pneumonia

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

D. The correct instruction to include in a discharge teaching plan for an adult client with hypernatremia is to review food labels for sodium content. Hypernatremia is a condition characterized by high levels of sodium in the blood, and it is often due to fluid loss rather than excessive sodium intake.

A. Hypernatremia is characterized by elevated levels of sodium in the blood, and reducing sodium intake is typically part of the treatment plan. Instructing the client to use salt tablets would exacerbate the hypernatremia and could lead to further complications.

B. This instruction is not directly related to managing hypernatremia. While monitoring urine output is important for assessing hydration status and kidney function, it may not specifically address the underlying cause of hypernatremia.

C. Hypernatremia is often caused by dehydration or inadequate water intake, leading to elevated sodium levels in the blood. Therefore, hydrating is an important instruction but not the most important.

A. Corneal abrasion B. Radiation exposure C. Foreign body D. Chemical burn

Correct Answer is A

Explanation

A. A corneal abrasion is a condition that may be exacerbated by the use of ketorolac due to its potential to delay healing and increase bleeding risks. Therefore, it is essential to ensure that a patient does not have a corneal abrasion before administering ophthalmic ketorolac.

B. Radiation exposure is not directly relevant to the administration of ophthalmic ketorolac.

C. The presence of a foreign body is not directly related to ketorolac use

D. The presence of a chemical burn is not related with ketorolac use in a client.

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Patient Data Exhibits What order(s) would the nurse question? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which instruction should the nurse include in the discharge teaching plan for an adult client with hypernatremia?

Correct Answer is D

Explanation

A client receives a prescription for ophthalmic ketorolac, Prior to administering the medication, the nurse should review the medical record for which condition?

Correct Answer is A

Explanation

Patient Data Exhibits What order(s) would the nurse question? (Select all that apply.)

While changing a client's postoperative dressing, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

The nurse is caring for a client who has been admitted with a diagnosis of esophageal cancer. The client reports a pain level of 8 on a 0 to 10 pain scale, dysphagia, anorexia, anxiety and a hoarse voice. Which nursing problem is the priority for this client?

The nurse is admitting a client with possible tuberculosis (TB). The client is placed in a private room with airborne precautions pending diagnostic test results. Which diagnostic test should the nurse review to confirm the diagnosis of TB?

A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which pathophysiological process supports the client's respiratory acidosis?

Which information should the nurse include when giving discharge instructions to a client following a left eye cataract extraction with a lens implant?

Patient Data

Exhibits

What order(s) would the nurse question? (Select all that apply.)