Extract:

Question 1 of 5

The nurse is teaching a client with gout about dietary management. Which of the following foods should the client avoid?

Correct Answer: C

Rationale: Organ meats are high in purines, which increase uric acid levels and should be avoided in gout.

Question 2 of 5

What is the purpose of administering diphenhydramine before a blood transfusion?

A. To prevent urticaria B. To avoid fever and chills C. To enhance clotting factors D. To expand the blood volume

Correct Answer: A

Rationale: The clinical indicators of urticaria are a rash accompanied by pruritus. Urticaria is a manifestation of a transfusion reaction when it occurs during a blood transfusion and is preventable by premedicating the client with an antihistamine, such as diphenhydramine. The remaining options are incorrect. Clients can also be premedicated with acetaminophen to help prevent fever and chills.

Question 3 of 5

A client with chronic kidney disease is on a fluid restriction. How should the nurse calculate the client's daily fluid intake?

A. Based on urine output plus 500 mL B. 1,000 mL regardless of weight C. 20 mL/kg of body weight D. Unlimited unless edema is present

Correct Answer: A

Rationale: Fluid intake in chronic kidney disease is typically calculated as urine output plus 500 mL to replace insensible losses while preventing fluid overload.

Question 4 of 5

The nurse is preparing to do tracheostomy care on a client. Which tracheostomy care items should the nurse obtain to perform this procedure?

A. Suction kit and tracheostomy dressing B. Bottle of sterile saline and a tracheostomy care kit C. Bottles of sterile saline and water and a tracheostomy dressing D. Tracheostomy care kit, sterile saline and water, and a suction kit

Correct Answer: D

Rationale: Equipment needed to perform tracheostomy care includes a tracheostomy care kit, sterile water and saline solutions for cleansing and rinsing, and a suction kit for client suctioning. As part of tracheostomy care, the client's airway should be suctioned before cleansing the tracheostomy. New sterile solutions are obtained once per 24 hours, which is often done at the beginning of the workday. A tracheostomy care kit contains the needed supplies for cleaning the tracheostomy and for changing the dressing and holder (trach ties).

Question 5 of 5

When a daily dose of fluoxetine hydrochloride is prescribed for a client, the nurse provides instructions regarding its administration. Which statement by the client indicates an understanding regarding the administration of the medication?

A. I should take the medication with food only. B. It is best to take the medication in the morning. C. I should take the medication at bedtime with a snack. D. I should take the medication at noontime with an antacid.

Correct Answer: B

Rationale: A daily dose of fluoxetine hydrochloride, a selective serotonin reuptake inhibitor (SSRI), should be taken in the morning. If the medication is prescribed more than once daily, then the client is instructed to take the last dose of the day before 4:00 pm to avoid insomnia. It does not have to be taken with food. Antacids are avoided with its administration because the antacid will affect absorption.