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QCHP/DHP Nurse Exam study materials
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QCHP/DHP Nurse Exam practice questions

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Question 1Adult Health and Medical-Surgical Nursing

A client with newly diagnosed stage 1 hypertension asks the nurse which lifestyle change is most likely to lower blood pressure. Which response is best?

  1. Take a multivitamin every morning
  2. Increase intake of caffeinated beverages
  3. Restrict dietary sodium intake Correct answer.
  4. Limit physical activity to avoid strain on the heart

Explanation

Sodium restriction lowers blood pressure in most people with hypertension and is a first-line lifestyle measure alongside weight loss and regular exercise. Multivitamins and caffeinated beverages have no antihypertensive effect, and limiting activity removes exercise, which itself lowers blood pressure.

Question 2Adult Health and Medical-Surgical Nursing

The nurse teaches a client to use an incentive spirometer after abdominal surgery. Which instruction is correct?

  1. Perform the exercise once per shift
  2. Use the device only when shortness of breath occurs
  3. Exhale forcefully into the mouthpiece as fast as possible
  4. Inhale slowly and deeply to raise the piston, then hold the breath briefly Correct answer.

Explanation

Slow, deep inhalation raises the piston and holding the breath keeps alveoli expanded, which prevents atelectasis after abdominal surgery. The device is most effective when used about 10 times every hour while awake, not only when symptoms appear or once per shift.

Question 3Adult Health and Medical-Surgical Nursing

A client taking digoxin reports anorexia, nausea, and blurred vision with yellow halos around lights. Which action should the nurse take first?

  1. Document the findings as an expected effect
  2. Encourage increased oral fluids
  3. Withhold the dose and notify the provider Correct answer.
  4. Administer the next scheduled dose

Explanation

Anorexia, nausea, and visual disturbances such as yellow halos are classic signs of digoxin toxicity, so the dose is held, the provider is notified, and serum digoxin and potassium levels are checked. Continuing the drug risks life-threatening dysrhythmias.

Question 4Adult Health and Medical-Surgical Nursing

A client taking warfarin for atrial fibrillation has an INR of 6.2 and no active bleeding. Which action does the nurse anticipate?

  1. Holding warfarin and administering vitamin K as prescribed Correct answer.
  2. Increasing the warfarin dose
  3. Continuing the current dose and rechecking the INR in one week
  4. Administering protamine sulfate

Explanation

An INR of 6.2 is well above the therapeutic range of 2 to 3 used for atrial fibrillation and carries a high bleeding risk, so warfarin is held and vitamin K is given as prescribed. Protamine reverses heparin, not warfarin, and continuing or increasing the dose would worsen the coagulopathy.

Question 5Adult Health and Medical-Surgical Nursing

A client with type 1 diabetes is diaphoretic, tremulous, and confused, with a fingerstick glucose of 52 mg/dL. The client can swallow. What should the nurse give first?

  1. Nothing by mouth and call the provider
  2. 15 g of a fast-acting carbohydrate such as 4 oz of juice Correct answer.
  3. A dose of regular insulin as prescribed
  4. A snack containing mostly protein and fat

Explanation

A conscious client with glucose below 70 mg/dL needs 15 g of fast-acting carbohydrate, with the glucose rechecked in 15 minutes and the dose repeated if still low. Insulin would lower glucose further, and protein or fat slows absorption of glucose.

Question 6Adult Health and Medical-Surgical Nursing

A client with diabetic ketoacidosis has a glucose of 480 mg/dL, arterial pH 7.18, and a potassium level of 5.4 mEq/L. Which prescribed order should the nurse implement first?

  1. Potassium chloride IV
  2. Sodium bicarbonate IV
  3. Regular insulin IV bolus
  4. 0.9% sodium chloride IV infusion Correct answer.

Explanation

In diabetic ketoacidosis, isotonic crystalloid is started first to restore intravascular volume and tissue perfusion before insulin and potassium adjustments. Bicarbonate is not routinely given, and potassium is not infused until the level is known to be low with adequate urine output.

Question 7Adult Health and Medical-Surgical Nursing

The nurse cares for a client with a chest tube connected to a water-seal drainage system. Which finding requires immediate intervention?

  1. Continuous bubbling in the water-seal chamber Correct answer.
  2. Serosanguineous drainage of 50 mL in the first hour
  3. Drainage tubing positioned below the level of the chest
  4. Tidaling of fluid in the water-seal chamber with respiration

Explanation

Continuous bubbling in the water-seal chamber indicates an air leak in the system that prevents resolution of the pneumothorax, so the tubing and insertion site are checked immediately. Tidaling with respiration is expected, and the drainage system must remain below chest level.

Question 8Adult Health and Medical-Surgical Nursing

Which action is appropriate when suctioning a client with a tracheostomy?

  1. Limit each pass to 10 seconds and hyperoxygenate between passes Correct answer.
  2. Suction continuously for up to 30 seconds per pass
  3. Instill 5 mL of normal saline before each pass
  4. Apply suction while inserting the catheter

Explanation

Each suction pass should last no longer than 10 seconds, with hyperoxygenation between passes, to prevent hypoxemia and mucosal trauma. Suction is applied only while withdrawing the catheter, and routine saline instillation is no longer recommended.

Question 9Adult Health and Medical-Surgical Nursing

A client has a full-thickness pressure injury with visible subcutaneous fat but no exposed muscle, tendon, or bone. How should the nurse document this injury?

  1. Deep tissue pressure injury
  2. Stage 4 pressure injury
  3. Stage 2 pressure injury
  4. Stage 3 pressure injury Correct answer.

Explanation

A stage 3 injury involves full-thickness skin loss with visible subcutaneous fat but no exposed muscle, tendon, cartilage, or bone. Stage 2 is partial-thickness loss, stage 4 exposes deeper structures, and deep tissue injury presents as intact, discolored skin.

Question 10Adult Health and Medical-Surgical Nursing

A client with COPD and a history of carbon dioxide retention has an SpO2 of 86%. What oxygen target should the nurse use?

  1. Titrate oxygen to keep SpO2 at 99% to 100%
  2. Withhold oxygen until the client becomes unresponsive
  3. Titrate oxygen to a target SpO2 of 88% to 92% Correct answer.
  4. Maintain SpO2 at 100% at all times

Explanation

Clients with COPD who retain carbon dioxide are oxygenated to a target SpO2 of 88% to 92%, which corrects hypoxemia without worsening hypercapnia. Withholding oxygen is dangerous, and aiming for 100% risks carbon dioxide narcosis.

Question 11Adult Health and Medical-Surgical Nursing

Which instruction should the nurse give a client with heart failure to detect fluid overload at home?

  1. Weigh yourself daily at the same time and report a gain of 2 to 3 lb in one day Correct answer.
  2. Restrict all fluids to 500 mL per day
  3. Take an extra dose of furosemide whenever short of breath
  4. Weigh yourself once a month

Explanation

Daily weights taken at the same time on the same scale detect fluid retention early; a gain of 2 to 3 lb in a day or about 5 lb in a week should be reported. Monthly weights are too infrequent, and clients should never adjust diuretic doses themselves.

Question 12Adult Health and Medical-Surgical Nursing

Which laboratory value is most specific for myocardial injury in a client with suspected acute myocardial infarction?

  1. Aspartate aminotransferase
  2. Myoglobin
  3. Troponin I Correct answer.
  4. Creatine kinase-MB

Explanation

Cardiac troponin I and T are highly specific to myocardial tissue and remain elevated for one to two weeks, making them the preferred markers. Creatine kinase-MB is less specific because skeletal muscle also contains it, and myoglobin rises early but lacks cardiac specificity.

Question 13Adult Health and Medical-Surgical Nursing

A client with an ischemic stroke arrived 90 minutes after symptom onset. Which finding contraindicates intravenous thrombolytic therapy?

  1. Symptom onset 90 minutes ago
  2. Current warfarin use with an INR of 3.0 Correct answer.
  3. Age 72 years
  4. Blood pressure 168/94 mmHg

Explanation

Therapeutic anticoagulation with warfarin and an INR above 1.7 is an absolute contraindication to intravenous thrombolysis because of the risk of intracranial hemorrhage. Presentation within 4.5 hours, older age, and a blood pressure below 185/110 mmHg do not exclude the client.

Question 14Adult Health and Medical-Surgical Nursing

Which action should the nurse take during a client's generalized tonic-clonic seizure?

  1. Restrain the client's arms and legs
  2. Give oral fluids to prevent dehydration
  3. Turn the client to the side and protect the head Correct answer.
  4. Insert a padded tongue blade between the teeth

Explanation

The priorities during a generalized seizure are airway protection and injury prevention, so the client is turned to the side, clothing is loosened, and the head is cushioned. Nothing is forced into the mouth, and restraints increase the risk of fracture.

Question 15Adult Health and Medical-Surgical Nursing

A client weighing 70 kg has burns over 40% of the total body surface area. Using the Parkland formula of 4 mL/kg/%TBSA, what volume should be infused in the first 8 hours after the burn?

  1. 11,200 mL
  2. 5,600 mL Correct answer.
  3. 1,400 mL
  4. 2,800 mL

Explanation

The Parkland formula gives 4 mL x 70 kg x 40% = 11,200 mL for the first 24 hours, with half given in the first 8 hours from the time of injury. That first-8-hour volume is 5,600 mL, and the remaining 5,600 mL is given over the next 16 hours.

Question 16Adult Health and Medical-Surgical Nursing

A client receiving 0.9% sodium chloride at 150 mL/hr develops dyspnea, crackles, and jugular venous distention. Which action should the nurse take first?

  1. Administer the next scheduled antibiotic
  2. Increase the rate to maintain urine output
  3. Slow the infusion and notify the provider Correct answer.
  4. Place the client in a supine position

Explanation

Dyspnea, crackles, and jugular venous distention indicate fluid overload, so the infusion is slowed, the provider is notified, and the client is positioned upright to ease breathing. Continuing or increasing the fluid worsens pulmonary edema.

Question 17Adult Health and Medical-Surgical Nursing

Which electrocardiographic change is most characteristic of hyperkalemia?

  1. Prominent U waves
  2. Prolonged QT interval
  3. Peaked T waves Correct answer.
  4. Atrial fibrillation with a slow ventricular response

Explanation

Hyperkalemia first produces tall, narrow, peaked T waves, which progress to QRS widening and a sine-wave pattern as the potassium rises. U waves suggest hypokalemia, and a prolonged QT interval suggests hypocalcemia or hypomagnesemia.

Question 18Adult Health and Medical-Surgical Nursing

Which client is at highest risk for hypokalemia?

  1. A client with adrenal insufficiency
  2. A client with chronic kidney disease requiring dialysis
  3. A client taking an ACE inhibitor
  4. A client with prolonged vomiting and nasogastric suction Correct answer.

Explanation

Vomiting and nasogastric suction remove potassium-rich gastrointestinal fluid and cause a metabolic alkalosis that shifts potassium into cells, so hypokalemia is likely. Kidney failure, ACE inhibitors, and adrenal insufficiency all tend to raise serum potassium.

Question 19Adult Health and Medical-Surgical Nursing

A client is 12 hours post-total thyroidectomy and reports tingling around the mouth and in the fingertips. Which action should the nurse take?

  1. Encourage coughing and deep breathing
  2. Assess for a positive Chvostek sign and notify the provider Correct answer.
  3. Administer levothyroxine as prescribed
  4. Document the finding as a normal postoperative sensation

Explanation

Perioral and fingertip paresthesias after thyroidectomy suggest hypocalcemia from inadvertent parathyroid injury, so the nurse checks for Chvostek and Trousseau signs and reports the finding for calcium replacement. Levothyroxine replaces thyroid hormone and does not treat hypocalcemia.

Question 20Adult Health and Medical-Surgical Nursing

A client with Addison disease is admitted with vomiting, hypotension, and confusion. Which order should the nurse implement first?

  1. Oral prednisone
  2. Potassium-sparing diuretic
  3. IV hydrocortisone with 0.9% sodium chloride Correct answer.
  4. Insulin infusion

Explanation

Adrenal crisis is treated immediately with IV hydrocortisone plus isotonic saline to replace glucocorticoid and restore intravascular volume. Insulin and potassium-sparing diuretics would worsen hypotension and hyperkalemia.

Question 21Adult Health and Medical-Surgical Nursing

Which statement by a client with a new colostomy indicates correct understanding of ostomy care?

  1. I will cut the skin barrier opening larger than the stoma
  2. I should avoid all fruits and vegetables
  3. I will empty the pouch when it is about one-third to one-half full Correct answer.
  4. I will change the pouch every day whether it leaks or not

Explanation

Emptying the pouch when it is one-third to one-half full prevents leakage and seal failure caused by weight. Convex barriers are changed every few days to a week, the opening is cut to fit snugly around the stoma, and most foods can be eaten.

Question 22Adult Health and Medical-Surgical Nursing

Which method most reliably confirms initial placement of a nasogastric feeding tube?

  1. Placing the tube tip in water and watching for bubbles
  2. Asking the client to speak
  3. Auscultating a whoosh of air over the epigastrium
  4. Testing the pH of aspirate together with radiograph confirmation Correct answer.

Explanation

Radiographic confirmation is the most reliable method for initial tube placement, and an aspirate pH below 5.5 supports gastric position. Auscultating an air whoosh is unreliable, and the absence of bubbles or the ability to speak does not prove gastric placement.

Question 23Adult Health and Medical-Surgical Nursing

Which nursing action best reduces the risk of catheter-associated urinary tract infection?

  1. Irrigating the catheter routinely every shift
  2. Changing the indwelling catheter every 48 hours
  3. Maintaining a closed system with the drainage bag below bladder level Correct answer.
  4. Disconnecting the tubing to obtain urine samples

Explanation

Maintaining a closed drainage system with the bag below the level of the bladder prevents backflow of bacteria into the bladder and is a core prevention measure. Routine irrigation, frequent catheter changes, and breaking the system for specimens all increase infection risk.

Question 24Adult Health and Medical-Surgical Nursing

A client receiving morphine by patient-controlled analgesia has a respiratory rate of 8/min and is difficult to arouse. Naloxone is ordered. Which action should the nurse take?

  1. Give naloxone only if the client becomes unresponsive
  2. Increase the PCA demand dose
  3. Stop the PCA, stimulate the client, and give naloxone as prescribed Correct answer.
  4. Place the client supine and continue monitoring

Explanation

Sedation with a respiratory rate of 8/min indicates opioid-induced respiratory depression, so the opioid is stopped, the client is stimulated, and naloxone is given as ordered with oxygen support. Waiting until unresponsiveness risks respiratory arrest.

Question 25Adult Health and Medical-Surgical Nursing

A client with pneumonia has a temperature of 39.2°C, heart rate 118/min, respiratory rate 24/min, blood pressure 88/52 mmHg, and a lactate level of 3.4 mmol/L. Which action should the nurse take first?

  1. Give an antipyretic and reassess in one hour
  2. Obtain blood cultures and begin broad-spectrum antibiotics and 30 mL/kg crystalloid Correct answer.
  3. Give oral fluids and position the client in high Fowler position
  4. Repeat the lactate level in four hours

Explanation

Hypotension with a lactate of 3.4 mmol/L in a client with suspected infection meets sepsis criteria with hypoperfusion, so the sepsis bundle of cultures, broad-spectrum antibiotics, and 30 mL/kg crystalloid begins immediately. Delaying treatment allows progression to septic shock with organ failure.

Question 26Adult Health and Medical-Surgical Nursing

A client with type 1 diabetes has a blood glucose of 52 mg/dL. The client is alert and able to swallow. Which action should the nurse take first?

  1. Administer the client's usual dose of subcutaneous insulin
  2. Give 15 g of a fast-acting oral carbohydrate Correct answer.
  3. Give an intramuscular injection of glucagon immediately
  4. Provide a meal high in fat and protein before rechecking

Explanation

A conscious client who can swallow is treated with 15 g of a rapid-acting carbohydrate, such as 4 oz of juice or 3 glucose tablets. The glucose is rechecked in 15 minutes and the treatment repeated if the value remains low. Fat and protein are added only after the glucose has been corrected, because they slow absorption.

Question 27Adult Health and Medical-Surgical Nursing

Which instruction should the nurse give a client after abdominal surgery to promote effective coughing?

  1. Hold your breath as long as possible before you cough
  2. Take several rapid, shallow breaths before coughing
  3. Splint the incision with a pillow while you cough Correct answer.
  4. Cough while lying flat on your back without support

Explanation

Splinting the incision supports the surgical wound, reduces pain, and allows the client to produce a deep, forceful cough that clears secretions. A slow deep breath should precede the cough. Shallow breathing and prolonged breath holding do not clear the airways.

Question 28Adult Health and Medical-Surgical Nursing

A client is being discharged on digoxin. Which instruction should the nurse include?

  1. Count the apical pulse for one minute before each dose Correct answer.
  2. Expect the heart rate to increase while taking this drug
  3. Take the medication with a fiber supplement every morning
  4. Take the pulse for 15 seconds and record the rate

Explanation

Digoxin slows conduction through the atrioventricular node, so the client should count the apical rate for a full minute before each dose and hold the drug for a rate below the prescribed threshold. A full-minute apical count also detects an irregular rhythm. Fiber can bind the drug and reduce its absorption.

Question 29Adult Health and Medical-Surgical Nursing

Which instruction should the nurse include for a client prescribed warfarin?

  1. Increase your intake of leafy green vegetables to protect the liver
  2. Keep your vitamin K intake about the same each day Correct answer.
  3. Double the dose on days when you miss a morning dose
  4. Take aspirin for headaches without checking with your provider

Explanation

Warfarin blocks vitamin K–dependent clotting factors, so a sudden change in vitamin K intake alters the INR and bleeding risk. The goal is a consistent intake rather than avoidance. Any new drug, including over-the-counter aspirin, must be approved by the provider because of additive bleeding risk.

Question 30Adult Health and Medical-Surgical Nursing

Which intervention should the nurse include in the plan of care after a posterior-approach total hip replacement?

  1. Flex the client's hip past 90 degrees when turning
  2. Have the client sit in a low recliner chair for meals
  3. Keep the legs abducted with a pillow between them Correct answer.
  4. Keep the client's knees together during repositioning

Explanation

A posterior-approach prosthesis is dislocated by hip flexion beyond 90 degrees, adduction, and internal rotation. An abduction pillow keeps the legs apart and prevents these movements. The client should also use a high-seated chair with armrests and avoid crossing the legs.

Question 31Adult Health and Medical-Surgical Nursing

A client becomes febrile and reports chills and flank pain 10 minutes into a blood transfusion. Which action should the nurse take first?

  1. Obtain a urine specimen and then restart the transfusion
  2. Give the prescribed PRN acetaminophen and continue
  3. Slow the infusion and reassess the client in 15 minutes
  4. Stop the transfusion and keep the line open with saline Correct answer.

Explanation

Fever, chills, and flank pain early in a transfusion suggest an acute hemolytic reaction. The transfusion must be stopped at once and the intravenous line maintained with 0.9% sodium chloride through new tubing. The provider and blood bank are notified and the unit is returned for investigation.

Question 32Adult Health and Medical-Surgical Nursing

Which hourly urine output should the nurse consider the minimum acceptable for a stable 60-kg adult?

  1. 20 mL/hr
  2. 10 mL/hr
  3. 30 mL/hr Correct answer.
  4. 75 mL/hr

Explanation

Adequate renal perfusion produces at least 0.5 mL/kg/hr of urine, which equals 30 mL/hr for a 60-kg adult. Output below this suggests hypovolemia or impaired renal perfusion and should be reported. Higher outputs simply exceed the minimum and are not the threshold.

Question 33Adult Health and Medical-Surgical Nursing

Which item should the nurse remove from the room of a client with severe neutropenia?

  1. The client's personal electric razor kept in a drawer
  2. A sealed box of tissues on the bedside table
  3. The client's own soft-bristled toothbrush in the bathroom
  4. Fresh flowers in standing water Correct answer.

Explanation

Standing water and fresh plants or flowers harbour Pseudomonas and other organisms that can cause overwhelming infection in a client with few neutrophils. They are excluded from the room along with raw fruits and vegetables. Personal items that are not shared, such as an electric razor, are permitted.

Question 34Adult Health and Medical-Surgical Nursing

Which laboratory test should the nurse monitor for a client receiving a continuous intravenous heparin infusion?

  1. Bleeding time
  2. INR
  3. aPTT Correct answer.
  4. Prothrombin time

Explanation

Unfractionated heparin prolongs the activated partial thromboplastin time, which is used to titrate the infusion to the prescribed therapeutic range. Warfarin, in contrast, is monitored with the INR and prothrombin time. Platelet counts are also checked to detect heparin-induced thrombocytopenia.

Question 35Adult Health and Medical-Surgical Nursing

A client with a traumatic brain injury develops a blood pressure of 180/60 mm Hg, a pulse of 48/min, and irregular respirations. Which interpretation is correct?

  1. These findings suggest early hypovolemic shock
  2. These findings are expected after a head injury
  3. They indicate rising intracranial pressure Correct answer.
  4. These findings suggest a vagal response to pain

Explanation

Systolic hypertension with a widened pulse pressure, bradycardia, and irregular respirations form Cushing triad, a late sign of increased intracranial pressure and impending herniation. It requires immediate provider notification and preparation for interventions to lower intracranial pressure. It is never an expected finding.

Question 36Adult Health and Medical-Surgical Nursing

Which position should the nurse suggest for a client with acute pancreatitis who reports severe abdominal pain?

  1. Supine with the head of the bed elevated 45 degrees
  2. Sitting upright and leaning slightly forward
  3. Prone with a pillow under the abdomen
  4. Side-lying with the knees drawn up to the chest Correct answer.

Explanation

A side-lying position with the knees flexed toward the chest relaxes the abdominal wall and reduces tension on the inflamed pancreas. In addition to positioning, the client is kept NPO and given prescribed analgesia. Supine and prone positions stretch the abdomen and worsen pain.

Question 37Adult Health and Medical-Surgical Nursing

A client with a new ileostomy is at risk for which fluid and electrolyte problem?

  1. Hyperkalemia from potassium retention
  2. Hypovolemia with hypokalemia Correct answer.
  3. Metabolic alkalosis from gastric losses
  4. Fluid overload with hypertension

Explanation

Ileostomy effluent is liquid and rich in sodium, potassium, and bicarbonate, so high-volume losses cause dehydration, hypokalemia, and metabolic acidosis. The nurse monitors output, replaces fluids, and teaches the client to drink electrolyte-containing fluids. Output is expected to thicken over weeks as the bowel adapts.

Question 38Adult Health and Medical-Surgical Nursing

Which adverse effect should the nurse teach a client taking phenytoin to report to the provider?

  1. Swollen, tender gums Correct answer.
  2. Increased appetite with weight gain
  3. Frequent loose stools
  4. Mild constipation

Explanation

Gingival hyperplasia is a common dose-related effect of phenytoin and needs provider evaluation along with consistent oral hygiene and dental follow-up. Other effects to report include rash, ataxia, and slurred speech. Clients should also be taught not to stop the drug abruptly.

Question 39Adult Health and Medical-Surgical Nursing

A client with SIADH has a serum sodium of 122 mEq/L. Which finding should the nurse expect?

  1. Serum osmolality of 310 mOsm/kg
  2. Urine output of 3 L per day with dilute urine
  3. Concentrated urine with high specific gravity Correct answer.
  4. Increased thirst with polyuria

Explanation

In SIADH, excess antidiuretic hormone causes water retention, producing concentrated urine with a high specific gravity and a low serum osmolality. Treatment includes fluid restriction and monitoring for neurologic changes from hyponatremia. Polyuria with dilute urine is the pattern of diabetes insipidus.

Question 40Adult Health and Medical-Surgical Nursing

A client with a tibial fracture in a cast reports pain that worsens when the toes are passively extended and is not relieved by morphine. Which action should the nurse take?

  1. Elevate the leg above the level of the heart and reassess
  2. Notify the provider immediately Correct answer.
  3. Give the next analgesic dose and document the finding
  4. Apply an ice pack over the cast and reassess in one hour

Explanation

Pain that is out of proportion to the injury and worse with passive stretch of the distal muscles is the earliest sign of compartment syndrome. The provider must be notified immediately because delay leads to nerve and muscle necrosis and requires fasciotomy. The limb is kept at heart level, not elevated above it.

Question 41Adult Health and Medical-Surgical Nursing

A client starting rifampin for tuberculosis asks about orange-red discoloration of urine and tears. Which response should the nurse give?

  1. This means the liver is being damaged; stop the drug
  2. It is an expected effect that is harmless Correct answer.
  3. This effect will require a change in the medication
  4. This is a sign of an allergic reaction to the drug

Explanation

Rifampin predictably tints urine, sweat, tears, and contact lenses orange-red; the effect is harmless and reverses when therapy ends. Clients should be warned in advance and told that soft contact lenses may be permanently stained. True hepatotoxicity presents with jaundice, dark urine, and elevated liver enzymes.

Question 42Adult Health and Medical-Surgical Nursing

Which instruction should the nurse give a client prescribed alendronate for osteoporosis?

  1. Take it with water and remain upright 30 minutes Correct answer.
  2. Take it with breakfast and then lie down for a nap
  3. Take it at bedtime together with a calcium supplement
  4. Crush the tablet and mix it into applesauce

Explanation

Oral bisphosphonates are poorly absorbed and irritate the esophagus, so they are taken on an empty stomach with a full glass of plain water while remaining upright for at least 30 minutes. Food, calcium, and lying down all reduce absorption or increase mucosal injury. The tablet must be swallowed whole.

Question 43Adult Health and Medical-Surgical Nursing

A client on bed rest after a total hip replacement suddenly reports shortness of breath and pleuritic chest pain. Which complication should the nurse suspect first?

  1. Pneumonia
  2. Pulmonary embolism Correct answer.
  3. Anxiety attack
  4. Atelectasis from inadequate lung expansion

Explanation

Sudden dyspnea with pleuritic chest pain and tachycardia in an immobile postoperative client is the classic presentation of pulmonary embolism. The nurse should apply oxygen, raise the head of the bed, and notify the provider urgently. Venous stasis from immobility is the major modifiable risk factor.

Question 44Adult Health and Medical-Surgical Nursing

Which breakfast selection indicates that a client with chronic kidney disease and hyperkalemia understands dietary teaching?

  1. Orange juice, banana, and low-fat milk
  2. Cantaloupe, low-fat yogurt, and bran cereal
  3. Cream of wheat, tomato juice, and coffee
  4. Eggs, white toast, and apple juice Correct answer.

Explanation

Eggs, refined white bread, and apple juice are relatively low in potassium, making this the safest choice for a client with hyperkalemia. Oranges, bananas, cantaloupe, dairy products, bran, and tomato products are all high in potassium. The nurse reinforces reading labels and limiting these foods.

Question 45Adult Health and Medical-Surgical Nursing

A client with heart failure is prescribed furosemide. Which laboratory value should the nurse monitor most closely?

  1. Serum calcium
  2. Serum albumin
  3. Serum sodium
  4. Serum potassium Correct answer.

Explanation

Loop diuretics increase renal potassium excretion, and hypokalemia can precipitate life-threatening dysrhythmias, especially in a client who may also be taking digoxin. Potassium is monitored closely and replaced as prescribed. Sodium and calcium may also change but are less immediately dangerous.

Question 46Adult Health and Medical-Surgical Nursing

A client with acute respiratory distress syndrome has a PaO2 of 60 mm Hg while receiving an FiO2 of 0.8. Which ventilator strategy should the nurse anticipate?

  1. Low positive end-expiratory pressure to protect the lungs
  2. Continuous mandatory ventilation at the client's own rate
  3. Tidal volumes of about 6 mL/kg predicted body weight Correct answer.
  4. High tidal volumes to fully expand the alveoli

Explanation

Lung-protective ventilation uses low tidal volumes of roughly 6 mL/kg predicted body weight with adequate positive end-expiratory pressure to prevent volutrauma and barotrauma in injured alveoli. High tidal volumes increase mortality in ARDS. Permissive hypercapnia is accepted to protect the lungs.

Question 47Adult Health and Medical-Surgical Nursing

An adult with sepsis-induced hypotension arrives in the emergency department. Which prescription should the nurse anticipate implementing first?

  1. Infuse 30 mL/kg of isotonic crystalloid Correct answer.
  2. Transfuse 2 units of packed red blood cells
  3. Start a norepinephrine infusion at 5 mcg/min
  4. Give 100 mg of hydrocortisone intravenously

Explanation

Current sepsis guidance begins resuscitation with at least 30 mL/kg of isotonic crystalloid for hypotension or an elevated lactate, given rapidly while cultures and antibiotics are obtained. Vasopressors are added if hypotension persists after fluids. Corticosteroids are reserved for shock refractory to fluids and pressors.

Question 48Adult Health and Medical-Surgical Nursing

A client with cirrhosis and hepatic encephalopathy is receiving lactulose. Which finding indicates that the drug is having the intended effect?

  1. Two to three soft stools daily with clearer thinking Correct answer.
  2. The client reports cramping with watery stools
  3. The client has one formed stool every other day
  4. The client's serum ammonia level is 90 mcg/dL

Explanation

Lactulose traps ammonia in the bowel and is titrated until the client passes two to three soft stools per day with improvement in mental status. Overdosing causes watery stools, dehydration, and hypokalemia, which can worsen encephalopathy. Ammonia levels are followed but correlate poorly with symptoms.

Question 49Adult Health and Medical-Surgical Nursing

A client who has vomited for 4 days has a pH of 7.52, PaCO2 of 46 mm Hg, HCO3 of 36 mEq/L, and a serum potassium of 2.9 mEq/L. Which prescription should the nurse anticipate?

  1. Fluid restriction to 1 L per day
  2. Furosemide 40 mg intravenously
  3. Sodium bicarbonate given by slow intravenous push
  4. Normal saline with added potassium chloride Correct answer.

Explanation

The elevated pH with a high bicarbonate indicates metabolic alkalosis, and the raised PaCO2 shows respiratory compensation. Prolonged vomiting causes chloride and potassium loss, producing a chloride-responsive alkalosis that corrects with 0.9% sodium chloride plus potassium replacement. Bicarbonate and diuretics would worsen it.

Question 50Adult Health and Medical-Surgical Nursing

A client with Graves disease who stopped methimazole 5 days ago arrives with a temperature of 40.2°C, a heart rate of 148/min, agitation, and vomiting. Which condition should the nurse suspect?

  1. Myxedema coma
  2. Serotonin syndrome
  3. Thyroid storm Correct answer.
  4. Adrenal crisis

Explanation

Hyperthermia, marked tachycardia, agitation, and gastrointestinal symptoms in a client with untreated hyperthyroidism indicate thyroid storm, a life-threatening decompensation. Treatment includes cooling, antithyroid drugs, beta-blockade, and volume replacement. It is distinguished from the hypothermic, bradycardic presentation of myxedema coma.