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Question 1 of 5

The physician has ordered sublingual nitroglycerin for a client. Which of the following are contraindications for administration of sublingual or buccal medications? Select all that apply.

Correct Answer: C,D

Rationale: Red, irritated mucous membranes (
C) and dehydration (
D) impair sublingual absorption. Edentulous state (
A), mild dementia (
B), and aphasia (E) do not contraindicate sublingual administration.

Question 2 of 5

Skeletal traction is applied to the right femur of a client injured in a fall. The primary purpose of the skeletal traction is to:

Correct Answer: D

Rationale: Skeletal traction for a femoral injury aims to realign femoral bone fragments, promoting proper healing and preventing deformity.

Question 3 of 5

The chart of a client with schizophrenia states that the client has echolalia. The nurse can expect the client to:

Correct Answer: B

Rationale: Echolalia in schizophrenia involves repeating words or phrases spoken by others, reflecting impaired communication processing.

Question 4 of 5

The nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP). The nurse notes that the urine output is bright red with clots. Which of the following actions should the nurse take FIRST?

Correct Answer: B

Rationale: bright red urine with clots indicates potential bleeding, requiring immediate physician notification

Question 5 of 5

The nurse is reviewing labs on a group of adult clients. Which lab value would prompt the nurse to immediately notify the health care provider?

Correct Answer: A

Rationale: Hemoglobin of 4.8 g/dL is critically low, indicating severe anemia and requiring immediate provider notification. Other values are normal or near-normal.

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The physician prescribes captopril (Capoten) 25 mg po tid for the client with hypertension. Which of the following adverse reactions can occur with administration of Capoten?

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