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Questions 158

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Question 1 of 5

A physician's order reads: Administer KCl 10% oral solution 1.5 mL. The KCl bottle reads 20 mEq/15 mL. What dosage should the nurse administer to the infant?

Correct Answer: C

Rationale: 1.33 mEq = 1 mL, then 1.5 mL X = 1.99, or 2 mEq.

Question 2 of 5

The nurse is caring for a client with B-thalassemia major. Which therapy is used to treat B-thalassemia major?

Correct Answer: B

Rationale: B-thalassemia major causes severe anemia due to defective hemoglobin synthesis, requiring frequent blood transfusions to maintain hemoglobin levels. IV fluids, oxygen, and iron therapy (which can cause overload) are not primary treatments.

Question 3 of 5

A client delivered a term infant 1 hour ago. Her uterus on assessment is boggy and is U+1 in contrast to the previous assessment of U-2. The immediate nursing response is to:

Correct Answer: D

Rationale: Methergine is given following placental delivery to promote uterine contractions and prevent hemorrhage. Methergine may be administered in this clinical situation, but fundal massage would be the first response. Removal of retained placental fragments is done by the physician and is not the first response. If the fundus rises and is deviated, particularly to the right, the nurse should suspect bladder distention secondary to bladder and urethral trauma associated with birth and decreased bladder tone following delivery.
Therefore, women have a diminished sensation to void. A boggy fundus rises and is indicative of blood pooling, predisposing the woman to clot formation. Massage the uterus until firm.
Too vigorous massage will result in atonia. Clots may be expelled by a kneading motion of the uterus by the nurse.

Question 4 of 5

The physician has ordered synthetic thyroid medication for a patient with hypothyroidism. The nurse should instruct the client to:

Correct Answer: C

Rationale: Thyroid medication (e.g. levothyroxine) is best taken in the morning on an empty stomach with water to optimize absorption and align with the body’s circadian rhythm. Taking it with food or at other times may reduce efficacy.

Question 5 of 5

A client with a history of gout is receiving Allopurinol (Zyloprim). The nurse should teach the client to:

Correct Answer: A

Rationale: Allopurinol reduces uric acid, and increased fluid intake promotes uric acid excretion, preventing kidney stones. Dairy, empty stomach, and protein limits are not necessary.

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