Correct Answer: B

Rationale: During a seizure, the priority action for the nurse is to place the client on their side with their head forward. This position helps maintain an open airway and prevents aspiration of fluids or secretions. Restraint should never be used during a seizure as it can cause harm to the client. Performing a neurological assessment is important but not the immediate priority during an active seizure. While monitoring vitals is essential, ensuring the client's airway is clear takes precedence.

Correct Answer: A

Rationale: Corrected
Rationale: Atorvastatin, an HMG CoA reductase inhibitor, can lead to hepatotoxicity.
Therefore, monitoring liver function through regular tests is essential. Baseline liver function should be assessed, followed by tests at 12 weeks after starting therapy and periodically thereafter. This monitoring helps detect early signs of liver damage, including jaundice, nausea, and dark urine.

Incorrect

Choices
Rationale:

B) Renal function test is not directly affected by atorvastatin.

C) Hearing screenings and
D) Visual acuity screenings are not indicated for monitoring while on atorvastatin therapy.

Correct Answer: A

Rationale: A potassium level of 3.0 mEq/L indicates hypokalemia, which increases the risk of digoxin toxicity. In this case, the nurse should administer the digoxin without any modifications. Lowering the dose (
Choice
B) may not be necessary if the potassium level is not critically low. Monitoring serum potassium levels (
Choice
C) is important but should not delay the administration of digoxin. Discontinuing the medication (
Choice
D) is not the initial action to take unless the potassium levels become severely low and life-threatening.

Correct Answer: D

Rationale: When caring for a client receiving total parenteral nutrition (TPN), monitoring serum glucose levels is essential due to the impact TPN can have on glucose metabolism. Additionally, electrolytes like potassium should be monitored as they can be affected by TPN administration. Blood pressure monitoring is not directly related to TPN administration, making choices A and B the correct options to monitor in this scenario.

Correct Answer: B

Rationale: Heparin therapy requires monitoring of activated partial thromboplastin time (APTT) to ensure therapeutic levels. APTT reflects the intrinsic pathway of the clotting cascade and is used to assess the effectiveness and safety of heparin therapy. Monitoring INR levels is more relevant for assessing warfarin therapy, not heparin. Blood glucose levels are monitored for clients with diabetes or those on medications affecting glucose levels. Liver function tests are used to assess liver health and are not directly related to monitoring heparin therapy.