Before administering a laxative to a bedfast client, it is most important for the nurse to perform what assessment?
a-Observe the skin integrity of the client's rectal and sacral areas
b-assess the client strength in moving and turning in the bed
c-evaluate the client's ability to recognize th...
Hesi Pharmacology (ACTUAL)
Questions, Pharm Hesi Questions And
Answers
Before administering a laxative to a bedfast client, it is most important for the nurse to perform
what assessment?
a-Observe the skin integrity of the client's rectal and sacral areas
b-assess the client strength in moving and turning in the bed
c-evaluate the client's ability to recognize the urge to defecate
d-determine the frequency and consistency of bowel movements - ANS D
rationale
the nurse should ensure that the client is not experiencing diarrhea (answer choice D) before
administering a laxative, which will increase the frequency of bowel movements. answer choices
A,B,C R4 and assessments for the provision of care when the client experience is a valve, but
are of less priority then answer choice D which provides data about the possible need to hold
medication
A female client with multiple sclerosis reports having less fatigue and improved memory since
she began using the herbal supplement, ginkgo biloba. Which information is most important for
the nurse to include in the teaching plans for this client?
a-Aspirin and nonsteroidal anti-inflammatory drugs interact with ginkgo
b-nausea and diarrhea can occur when using this supplement
c-anxiety and headaches increased with use of ginkgo
d-ginkgo biloba use should be limited and not taken during pregnancy - ANS Rationale
ginkgo biloba has blood thinning properties and should not be used in taking aspirin or unsafe
which increased the risk for bleeding. nausea diarrhea anxiety and headaches are also side
effects of supplements but they do not pose the same risk as a. Although D is accurate A has a
higher priority
In explaining the benefits of the combination anti-infective drug code tri-moxazole/TMP-SMZ
(bactrium) to a client receiving the medication for a urinary tract infection, more rationale to the
nurse provide?
-Each drug could cause damage to the kidneys if taken separately
-one drug reduces the risk of side effects caused by the drug
-while one drug provide releif, the other fights the infection
, -the two drugs work together to reduce resistance of the bacterial infection of symptoms - ANS
D
rationale
the combination of drugs and bacteria work synergistically to reduce bacterial resistance
enterprise D, thereby increasing the drug therapeutic benefits answer choices a B &C are
incorrect rationales
Client being treated with Haldol for schizophrenia is complaining of jaw tightness & a stiff neck.
Which interventions should the nurse impliment?
-give PRN those of diphenhydramine Benadryl
-assess client other sensory hallucinations
-massage neck until muscles begin to relax
-obtain a 12 lead EKG - ANS Rationale
jaw tightness and a stiff neck are signs of tardive dyskinesia, a serious side effect of health all
that can be reversed with Benadryl answer choice A. the client complaints are not considered
hallucinations b. Massaging the neck does not eliminate the symptoms. A 12 lead EKG is not
indicated because the pain is not cardiac in origin.
Which intervention is most important for the nurse implement for a client is receiving lispro
Humalog insulin?
-Check blood glucose levels every six hours
-provide meals at the same time that insulin is given
-assess for hypoglycemia between meals
-keeping oral liquid or glucose source available - ANS B
Rationale
Humalog is a rapid acting insulin 15 minutes, so meals should be readily available time
administration of lispro (B). Although glucose blood levels a, monitoring for hypoglycemia see,
and keeping emergency source of glucose available B should be implemented for client
receiving any form of insulin those who take these are at greatest risk for rapid hypoglycemia
shortly after it is administered
Client takes nonsteroidal anti-inflammatory drugs every day for rheumatoid arthritis is being
treated for anemia which intervention is most important for the nurse to include any plan of care
observe for gastrointestinal bleeding
monitor liver function test results
protect skin from bruising
offered dietary selections rich in iron
rationale - ANS rationale
the client is at risk for gastrointestinal bleeding duty history of NSAID a .new onset anemia
indicates bleeding may be present. NSAIDS May impact liver function b, but this is of less
immediacy than a. C is a basic core measure but not one of high priority for this client. D often
useful for persons with anemia but is of less priority than a
When treating a patient with a hospital acquired infection with Vancomycin, what would you do?
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