Because the census is currently low in the Obstetrics (OB) unit, one of the nurses is sent to work on a medical-surgical unit for the day, or until the OB unit becomes busy. Which client assessment is best for the charge nurse to assign to the OB nurse?

Correct Answer: A

Rationale: The correct answer is A because the OB nurse's background in obstetrics makes them most suitable to care for a post-operative patient with an IV. This assignment aligns with the nurse's skill set and ensures safe and competent care. Choices B, C, and D involve medical-surgical conditions that may require specialized knowledge and skills beyond the OB nurse's expertise, potentially compromising patient care. Assigning the OB nurse to care for a post-operative patient with an IV is the most appropriate choice given the circumstances.

Correct Answer: C

Rationale: The correct answer is C: Administer IV adenosine (Adenocard). Rationale: 1. The ECG rhythm shows regular narrow complex tachycardia, likely supraventricular tachycardia (SVT). 2. Adenosine is the first-line medication for terminating SVT by blocking conduction through the AV node. 3. Adenosine is given rapidly as a bolus dose followed by a saline flush to ensure quick delivery to the heart. 4. Adenosine has a very short half-life, making it safe to use in this scenario. Summary: A: Magnesium is not the first-line treatment for SVT. B: Heparin is not indicated for the management of SVT. D: Synchronized cardioversion is reserved for unstable patients with hemodynamic compromise, not indicated for stable SVT.

Correct Answer: D

Rationale: Rationale: Option D is the correct answer because it directly addresses the client's experience with penicillin, providing crucial details about the allergic reaction. By asking what happens when the client takes penicillin, the nurse gains specific information to assess the severity and type of allergic reaction. This helps in determining appropriate interventions and alternative medications. Options A, B, and C are incorrect as they do not focus on gathering detailed information about the client's allergic reaction to penicillin. Option A is too broad, option B is not relevant to the current situation, and option C does not directly address the client's individual experience.

Correct Answer: A

Rationale: The correct answer is A: Rebound tenderness at McBurney's point. McBurney's point is located in the right lower quadrant and is a classic sign of appendicitis. Rebound tenderness at this point indicates inflammation in the peritoneum, suggesting appendicitis. Choices B, C, and D are not specific to appendicitis. Positive Murphy's sign is related to cholecystitis, Rovsing's sign is seen in acute appendicitis but is not as specific as rebound tenderness at McBurney's point, and Cullen's sign is associated with acute pancreatitis.

Correct Answer: D

Rationale: The correct answer is D: Teach them to limit sugar and caffeine intake. Rationale: 1. Sugar and caffeine intake can exacerbate anxiety and interfere with sleep due to their stimulant effects. 2. Limiting these substances can help regulate the body's energy levels and reduce anxiety symptoms. 3. By teaching the client to limit sugar and caffeine intake, the nurse is addressing the root causes of the client's sleeplessness and anxiety. Summary: A: Encouraging daily rituals may provide structure but does not directly address the physiological effects of sugar and caffeine on anxiety. B: Reinforcing the reality of the financial situation may increase anxiety rather than alleviate it. C: Drinking red wine at bedtime is not a recommended solution for managing anxiety and sleeplessness.

Correct Answer: A

Rationale: The correct answer is A: Continuous tube feeding at 65 ml/hr via gastrostomy. Dysphagia, hypoactive bowel sounds, and a distended abdomen indicate a potential risk for aspiration or impaired gastrointestinal motility. Continuous tube feeding may worsen these conditions. The nurse should question this prescription to prevent further complications. Choices B, C, and D are not immediate concerns for dysphagia and bowel issues. Total parenteral nutrition, nasogastric tube connected to suction, and metoclopramide can be appropriate interventions for nutritional support and bowel motility in this scenario.

Correct Answer: D

Rationale: Correct Answer: D Rationale: 1. Levothyroxine is a lifelong medication for hypothyroidism. 2. Stopping medication prematurely can lead to symptom relapse. 3. Symptoms improving doesn't indicate the underlying condition is resolved. 4. Regular monitoring and dose adjustments are crucial. 5. Choice D shows misunderstanding of treatment duration and necessity. Summary: A: Correct, taking in the morning maximizes absorption. B: Correct, monitoring is necessary for dose adjustments. C: Correct, weight loss can affect thyroid hormone levels. D: Incorrect, as stopping medication prematurely is not advised.

Correct Answer: C

Rationale: The correct answer is C: Monitor your blood glucose levels regularly. This is important because metformin helps lower blood sugar levels, and monitoring glucose levels helps ensure the medication is effective and the client is not experiencing hypoglycemia or hyperglycemia. Option A is incorrect because metformin should be taken with meals to reduce gastrointestinal side effects. Option B is incorrect as metformin does not typically require fluid restriction. Option D is incorrect as metformin does not affect potassium levels. Regularly monitoring blood glucose levels is crucial for managing type 2 diabetes effectively.

Correct Answer: B

Rationale: The correct answer is B: Hold the medication and notify the healthcare provider. The rationale is that metoprolol is a beta-blocker that can further decrease heart rate. With a low apical pulse of 58 beats/minute, administering metoprolol can potentially cause bradycardia or further slow down the heart rate to dangerous levels. Holding the medication and notifying the healthcare provider allows for further assessment and potential adjustment of the dosage or consideration of alternative treatments. Incorrect choices: A: Administering the medication as prescribed can lead to bradycardia and potential harm to the client. C: Giving half the prescribed dose and rechecking the pulse in 30 minutes can still lead to further bradycardia and potential harm. D: Administering the medication and then rechecking the pulse in 30 minutes is not appropriate as the initial pulse rate is already low, and waiting to recheck could lead to adverse effects before intervention.