A nurse is preparing to administer vancomycin IV to a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take?

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Question 1 of 5

A nurse is preparing to administer vancomycin IV to a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take?

Correct Answer: A

Rationale: The correct action the nurse should take is to administer the medication over 60 minutes. This is important because administering vancomycin over 60 minutes helps prevent red man syndrome, a reaction that can occur with rapid infusion. Monitoring the client's blood glucose level (Choice B) is unrelated to vancomycin administration. Infusing the medication rapidly (Choice C) is incorrect and can lead to adverse reactions. Administering the medication using a filter needle (Choice D) is unnecessary for vancomycin administration.

Question 2 of 5

A nurse is reviewing the medical record of a client who has a new prescription for insulin glargine. Which of the following should the nurse include in the teaching?

Correct Answer: B

Rationale: The correct answer is B. Insulin glargine has a 24-hour duration of action, making it suitable for once-daily dosing for long-term blood sugar control. Choice A is incorrect as insulin glargine is a long-acting insulin with no pronounced peak effect in its action profile. Choice C is incorrect as insulin glargine is usually given at the same time each day regardless of meals. Choice D is incorrect as there is no specific requirement to avoid eating before or after taking insulin glargine.

Question 3 of 5

A nurse is providing teaching to a client who has irritable bowel syndrome (IBS). Which of the following dietary recommendations should the nurse make?

Correct Answer: B

Rationale: The correct answer is B: "Avoid foods that are high in fat." Clients with IBS should avoid foods high in fat as they can exacerbate symptoms such as abdominal pain, bloating, and diarrhea. High-fiber foods, choice A, can sometimes worsen symptoms in individuals with IBS. Increasing intake of dairy products, choice C, may also worsen symptoms for some individuals with IBS, especially if they are lactose intolerant. Drinking carbonated beverages, choice D, can contribute to bloating and gas, making symptoms worse for individuals with IBS.

Question 4 of 5

A nurse is caring for a client who is 1 day postoperative following a below-the-knee amputation. Which of the following actions should the nurse take?

Correct Answer: C

Rationale: The correct action the nurse should take is to place the client in a prone position for 30 minutes four times a day. This position helps prevent contractures after an amputation by stretching the hip flexors and preventing shortening of the residual limb. Keeping the residual limb flat on the bed (Choice A) may lead to contractures. Elevating the residual limb on a pillow (Choice B) can also cause contractures and hinder proper healing. Keeping the residual limb dependent (Choice D) is not recommended as it does not promote proper positioning and circulation.

Question 5 of 5

A client who is postoperative following a colon resection reports pain. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: Administering a PRN dose of morphine is the most appropriate action to manage postoperative pain in a client following a colon resection. Morphine is a potent analgesic commonly used to relieve moderate to severe pain, especially in postoperative settings. While assisting the client to change positions in bed, encouraging relaxation techniques, and offering a back massage can provide comfort and support, they may not be sufficient in managing the pain following a major surgical procedure like a colon resection. Therefore, the priority intervention for acute postoperative pain control in this scenario is to administer medication like morphine.

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