Correct Answer: A

Rationale: Diltiazem, a calcium channel blocker, can cause hypotension. Administering it to a client who already has hypotension could exacerbate this condition.
Therefore, hypotension is a contraindication to the administration of diltiazem.

Incorrect

Choices:

B) Tachycardia is not a contraindication for administering diltiazem in atrial fibrillation as it is commonly used to control the heart rate.

C) Decreased level of consciousness may require evaluation but is not a direct contraindication to diltiazem administration.

D) History of diuretic use is not a contraindication if the client is not currently experiencing hypotension.

Correct Answer: A

Rationale: The correct answer is A: Jaundice. Sulfasalazine can cause liver damage as a possible adverse effect, which can manifest as jaundice. Monitoring for jaundice is crucial to detect liver-related adverse effects early.

Choices B, C, and D are incorrect. Constipation, oral candidiasis, and sedation are not typically associated with sulfasalazine use.
Therefore, the nurse should focus on educating the client specifically about monitoring for jaundice.

Correct Answer: A

Rationale: The correct answer is A because respiratory depression is a significant risk when administering morphine, and it can occur within 7 minutes after administration. This information is crucial for the nurse to recognize and respond promptly.
Choice B is incorrect because the peak effect of morphine via IV bolus is typically reached within a few minutes, not specifically 10 minutes.
Choice C is incorrect because withholding morphine based solely on a respiratory rate less than 16/min may not be appropriate without considering other factors such as pain level, oxygen saturation, and overall respiratory status.
Choice D is incorrect because administering morphine over 2 minutes may not prevent respiratory depression if it occurs rapidly after administration. Nurses should be vigilant for signs of respiratory depression regardless of the administration duration.

Correct Answer: D

Rationale: The correct answer is D, 'All of the Above.' Valproic acid can impact liver function and coagulation. Monitoring the Prothrombin Time (PTT), Aspartate Aminotransferase (AST), and Alanine Aminotransferase (ALT) is crucial. PTT is monitored to assess coagulation status, while AST and ALT are liver enzymes that indicate liver function. Monitoring these values helps detect any potential adverse effects of valproic acid on the liver and blood clotting.

Choices A, B, and C are incorrect because each of these laboratory values plays a critical role in evaluating the client's response to valproic acid therapy and detecting associated complications.

Correct Answer: B

Rationale: The correct answer is B: Proteinuria. Proteinuria can indicate nephrotoxicity, a known adverse effect of gentamicin. Gentamicin is known to cause kidney damage, leading to proteinuria. Hypoglycemia is not typically associated with gentamicin use but may be related to insulin administration or other medical conditions. Nasal congestion is not a common adverse effect of gentamicin. Visual disturbances are also not typically reported with gentamicin use.