Honey, a 23-year old client complains of substernal chest pain and states that her heart feels like "it's racing out of the chest". She reports no history of cardiac disorders. The nurse attaches her to a cardiac monitor and notes sinus tachycardia with a rate of 136beats/minutes. Breath sounds are clear and the respiratory rate is 26 breaths/minutes. Which of the following drugs should the nurse question the client about using?

Correct Answer: C

Rationale: The correct answer is C: Cocaine. Cocaine is a potent stimulant drug that can cause symptoms such as substernal chest pain, palpitations, and sinus tachycardia. Given the client's presentation of chest pain and racing heart, along with the absence of cardiac history, cocaine use should be considered and questioned. Barbiturates (A), opioids (B), and benzodiazepines (D) are less likely to cause sinus tachycardia and substernal chest pain compared to cocaine. It is important to focus on cocaine as a potential cause in this scenario due to its known cardiovascular effects.

Correct Answer: B

Rationale: The correct answer is B: It appears on the distal interphalangeal joint. Heberden's nodes are bony enlargements that occur at the distal interphalangeal joints, which are the joints closest to the fingertips. The nodes are a common sign of osteoarthritis in the fingers. They do not appear only in men (choice A), they do not appear on the proximal interphalangeal joint (choice C), and they do not appear on the dorsolateral aspect of the interphalangeal joint (choice D). The key to identifying Heberden's nodes is their location at the distal interphalangeal joint.

Correct Answer: D

Rationale: The correct answer is D: glycosylated hemoglobin level. This test provides an average of blood glucose levels over the past 2-3 months, reflecting the client's long-term glycemic control. It is a better indicator of overall diabetes management compared to other options. Urine glucose level (A) only provides a snapshot of glucose levels at the time of testing and is not a reliable long-term measure. Fasting blood glucose level (B) gives a point-in-time reading and may not reflect overall control. Serum fructosamine level (C) reflects average blood glucose levels over the past 2-3 weeks, which is shorter than the timeframe needed to assess the client's 3-month efforts.

Correct Answer: B

Rationale: The correct answer is B: Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. In anaphylactic shock, immediate administration of epinephrine is crucial to reverse the severe allergic reaction. Intubation may be necessary to maintain airway patency in case of severe respiratory distress. Choice A is incorrect because paging an anesthesiologist and preparing for intubation should not be the first action; administering epinephrine takes precedence. Choice C is incorrect as administering an antidote for penicillin would not address the immediate life-threatening symptoms of anaphylactic shock. Choice D is incorrect as inserting a urinary catheter and infusing IV fluids are not the priority actions in managing anaphylactic shock.

Correct Answer: D

Rationale: The correct answer is D because chills in a post-op patient could indicate the presence of infection, which is a serious concern post-surgery. The nurse should see this client first to assess for signs of sepsis. Choice A is incorrect as the small area of dark drainage in a gunshot wound client doesn't indicate immediate danger. Choice B is incorrect as the amount of fluid in the drain post-mastectomy is within normal limits. Choice C is incorrect as the absence of drainage in a collapsed lung client isn't an immediate priority compared to potential signs of infection in choice D.