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Questions 149

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Question 1 of 5

A client with paranoid schizophrenia has an order for Thorazine (chlorpromazine) 400 mg orally twice daily. Which of the following symptoms should be reported to the physician immediately?

Correct Answer: A

Rationale: Fever, sore throat, and weakness may indicate agranulocytosis, a serious side effect of chlorpromazine requiring immediate reporting.

Question 2 of 5

The nurse caring for the child with a large meningomylocele is aware that the priority care for this client is to:

Correct Answer: A

Rationale: Moist, sterile gauze prevents infection and drying of the meningomyelocele defect.

Question 3 of 5

The physician has ordered Vancocin (vancomycin) 500 mg IV every 6 hours for a client with MRSA. The medication should be administered:

Correct Answer: D

Rationale: Vancomycin should be infused over at least 60 minutes to prevent adverse reactions such as red man syndrome.

Question 4 of 5

A client is admitted with disseminated herpes zoster. According to the Centers for Disease Control Guidelines for Infection Control:

Correct Answer: A

Rationale: Disseminated herpes zoster requires airborne precautions due to the risk of varicella-zoster virus transmission through respiratory droplets and contact.

Question 5 of 5

A newly admitted client has sickle cell crisis. He is complaining of pain in his feet and hands. The nurse's assessment findings include a pulse oximetry of 92. Assuming that all the following interventions are ordered, which should be done first?

Correct Answer: C

Rationale: A pulse oximetry of 92 indicates hypoxemia, so administering oxygen is the priority to improve oxygenation and prevent further sickling.

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