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Which of the following symptoms might the nurse observe in a client with a lithium blood level over 2.0?
A. Gastric irritation, nausea, diarrhea
B. Vomiting, impaired consciousness, decreased blood pressure
C. Polyuria, polydipsia, edema
D. Fine hand tremor, headache, mental dullness
Answer: B
Explanation:
Explanation
(A) These symptoms are acute, common, and usually harmless central nervous system side effects of lithium.
(B) These symptoms of lithium toxicity are usually dose related. (C) These symptoms are acute, common, and usually harmless renal side effects of lithium. (D) These symptoms are acute, common, and usually harmless gastrointestinal side effects of lithium.
NEW QUESTION # 14
A nurse should carefully monitor a client for the following side effect of MgSO4:
A. Tachypnea
B. Respiratory depression
C. Visual blurring
D. Epigastric pain
Answer: B
Explanation:
Explanation
(A, C) The nurse should provide good distractors because these symptoms indicate that PIH has become more severe and may precede the convulsive or eclamptic phase. (B) This is the oppositeside effect of this medication. (D) This is a common side effect of this medication and needs to be monitored and recorded frequently.
NEW QUESTION # 15
A 33-year-old client was brought into the emergency room unconscious, and it is determined that surgery is needed. Informed consent must be obtained from his next of kin. The sequence in which the next of kin would be asked for the consent would be:
A. Parent, spouse, sibling, adult child
B. Spouse, parent, sibling, adult child
C. Parent, spouse, adult child, sibling
D. Spouse, adult child, parent, sibling
Answer: D
Explanation:
Section: Questions Set D
Explanation:
(A) Spouse and adult child would be asked before a parent. (B) The order of kin relationship for an adult, as determined from legal intestate succession, is usually spouse, adult child, parent, sibling. (C) Parent and sibling would be asked after adult child. (D) Spouse and adult child would be asked before parent. Sibling would be asked last.
NEW QUESTION # 16
A 55-year-old woman entered the emergency room by ambulance. Her primary complaint is chest pain.
She is receiving O2 via nasal cannula at 2 L/min for dyspnea. Which of the following findings in the client's nursing assessment demand immediate nursing action?
A. Associated symptoms of indigestion and nausea
B. Inability to tolerate assessment session with the admitting nurse
C. History of hypertension treated with pharmacological therapy
D. Restlessness and apprehensiveness
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Indigestion or nausea may accompany angina or myocardial infarction, but they do not indicate imminent danger for the client. (B) Restlessness and apprehensiveness require immediate nursing action because they are indicative of very low oxygenation of body tissues and are frequently the first indication of impending cardiac or respiratory arrest. (C) It is common for the cardiac client to experience fatigue and inability to physically tolerate long assessment sessions. (D) A history of hypertension requires no immediate nursing intervention. In the situation described, the blood pressure is not given and therefore cannot be assumed to be elevated.
NEW QUESTION # 17
When a client with pancreatitis is discharged, the nurse needs to teach him how to prevent another occurrence of acute pancreatitis. Which of the following statements would indicate he has an understanding of his disease?
A. "I will not eat any raw or uncooked vegetables."
B. "I will look into attending Alcoholics Anonymous meetings."
C. "I will limit my alcohol to one cocktail per day."
D. "I will report any changes in bowel movements to my doctor."
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Raw or uncooked vegetables are all right to eat postdischarge. (B) This client must avoid any alcohol intake. (C) The client displays awareness of the need to avoid alcohol. (D) This action would be pertinent only if fatty stools associated with chronic hepatitis were the problem.
NEW QUESTION # 18
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