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Questions 164

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Question 1 of 5

The doctor has ordered Lovenox (enoxaparin) 20 mg subcutaneously daily. The medication is available as 60 mg per mL. The nurse should administer:

Correct Answer: C

Rationale: Calculate: 20 mg ÷ 60 mg/mL = 0.333 mL, rounded to 0.33 mL for accurate dosing of Lovenox.

Question 2 of 5

The nurse caring for multiple clients on a medical-surgical unit should delegate which action to the nursing assistant?

Correct Answer: A

Rationale: Assisting with mobility, such as to the bathroom, is within the nursing assistant's scope. Wound assessment, tube discontinuation, and treating hypoglycemia require nursing judgment and are outside their scope.

Question 3 of 5

The nurse is teaching a client about communicable diseases and explains that a portal of entry is:

Correct Answer: D

Rationale: The path by which a microorganism enters the body is the portal of entry. A vector is a carrier of disease, a source (like bad water or food) can be a reservoir of disease.

Question 4 of 5

The unit secretary notifies the nurse that 4 clients called the nurses' station reporting pain. Which client should the nurse assess first?

Correct Answer: A

Rationale: Shoulder pain radiating down the arm post-amputation suggests a possible cardiac event (e.g., angina), a life-threatening condition requiring immediate assessment. Other pains, while severe, are more likely related to known conditions.

Question 5 of 5

The nurse is reinforcing discharge teaching to several clients with new prescriptions. Which instructions by the nurse about medication administration are correct? Select all that apply.

Correct Answer: A,D

Rationale: Salt substitutes (potassium-based) can cause hyperkalemia with valsartan. Ethambutol can cause optic neuritis, requiring vision change reports. Levofloxacin with antacids reduces absorption. Sucralfate is taken before meals to coat the stomach. Rifampin's red-orange urine is normal, not reportable.

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