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Questions 149

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Question 1 of 5

A client with hyperkalemia is admitted to the telemetry unit. Which of the following would require notification of the health care provider? Select all that apply.

Correct Answer: A, B

Rationale: Spiked T waves and bradycardia (heart rate 53) are signs of severe hyperkalemia, requiring immediate provider notification. Normal heart rate, food refusal, and adequate urinary output (30 cc/hr) are not urgent.

Question 2 of 5

The physician has prescribed Nexium (esomeprazole) for a client with erosive gastritis. The nurse should administer the medication:

Correct Answer: A

Rationale: Esomeprazole is most effective when taken 30 minutes before a meal to reduce acid production during digestion.

Question 3 of 5

The nurse is preparing to administer a dose of lisinopril (Zestril) to a client with hypertension. The client’s blood pressure is 100/60 mmHg. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: lisinopril is an ACE inhibitor

Question 4 of 5

When caring for a ventilator-dependent client who is receiving tube feedings, the nurse can help prevent aspiration of gastric secretions by:

Correct Answer: B

Rationale: Elevating the head of the bed 30-45° reduces the risk of aspiration in ventilator-dependent clients.

Question 5 of 5

The school nurse is assessing an elementary student with hemophilia who fell during recess. Which symptoms indicate hemarthrosis?

Correct Answer: D

Rationale: Hemarthrosis in hemophilia involves bleeding into joints, causing stiffness, aching, and reduced movement due to joint swelling and pain.

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