Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A. Reye syndrome
Reye syndrome is correct because administering aspirin to children, especially during viral illnesses like the flu, can lead to this serious and potentially fatal condition characterized by acute encephalopathy and liver failure.
B. Excess antiplatelet action
Excess antiplatelet action is incorrect; while aspirin does have antiplatelet effects, this is not the primary concern in a child with a viral illness.
C. Asthma
Asthma is incorrect; while some individuals with asthma may have sensitivity to aspirin, it is not specifically related to the child's flulike illness.
D. Salicylate poisoning
Salicylate poisoning is incorrect; while high doses of aspirin can lead to toxicity, the immediate risk in the context of flu-like illness is Reye syndrome, which is a more specific concern.
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Full Explanation
A. Reye syndrome is correct because administering aspirin to children, especially during viral illnesses like the flu, can lead to this serious and potentially fatal condition characterized by acute encephalopathy and liver failure.
B. Excess antiplatelet action is incorrect; while aspirin does have antiplatelet effects, this is not the primary concern in a child with a viral illness.
C. Asthma is incorrect; while some individuals with asthma may have sensitivity to aspirin, it is not specifically related to the child's flulike illness.
D. Salicylate poisoning is incorrect; while high doses of aspirin can lead to toxicity, the immediate risk in the context of flu-like illness is Reye syndrome, which is a more specific concern.
Similar Questions
The nurse is caring for a client who is experiencing pulmonary edema. The client is treated with furosemide. What will the nurse monitor most closely?
A. Sodium levels
Sodium levels are important to monitor, but they are not the primary concern with furosemide treatment.
B. Bone marrow function
Bone marrow function is not a direct concern related to furosemide therapy.
C. Calcium levels
Calcium levels are less critical compared to potassium when monitoring a client on furosemide.
D. Potassium levels
Potassium levels are correct because furosemide is a loop diuretic that can lead to significant potassium loss, putting the client at risk for hypokalemia, which can have serious cardiac implications.
Full Explanation
A. Sodium levels are important to monitor, but they are not the primary concern with furosemide treatment.
B. Bone marrow function is not a direct concern related to furosemide therapy.
C. Calcium levels are less critical compared to potassium when monitoring a client on furosemide.
D. Potassium levels are correct because furosemide is a loop diuretic that can lead to significant potassium loss, putting the client at risk for hypokalemia, which can have serious cardiac implications.
The nurse is caring for a client who has been admitted after an acetaminophen overdose. Which of the nurse's assessment findings suggest liver damage? (Select all that apply.)
A. The client's skin and eyes are visibly jaundiced.
The client's skin and eyes are visibly jaundiced is correct because jaundice indicates a buildup of bilirubin in the blood, which is a sign of liver dysfunction.
B. The client's AST and ALT levels are elevated.
The client's AST and ALT levels are elevated is correct because elevated levels of these liver enzymes indicate hepatocellular injury, which is consistent with liver damage due to acetaminophen overdose.
C. The client's temperature is 102.5° F (39.2° C).
The client's temperature is 102.5° F (39.2° C) is incorrect; while a fever can occur in various conditions, it is not specific for liver damage in this context.
D. The client has an elevated red blood cell count.
The client has an elevated red blood cell count is incorrect; elevated red blood cell counts are not indicative of liver damage and may be related to other factors.
E. The client's eyes are sensitive to light.
The client's eyes are sensitive to light is incorrect; photophobia is not a direct indicator of liver damage and is more related to other conditions.
Full Explanation
A. The client's skin and eyes are visibly jaundiced is correct because jaundice indicates a buildup of bilirubin in the blood, which is a sign of liver dysfunction.
B. The client's AST and ALT levels are elevated is correct because elevated levels of these liver enzymes indicate hepatocellular injury, which is consistent with liver damage due to acetaminophen overdose.
C. The client's temperature is 102.5° F (39.2° C) is incorrect; while a fever can occur in various conditions, it is not specific for liver damage in this context.
D. The client has an elevated red blood cell count is incorrect; elevated red blood cell counts are not indicative of liver damage and may be related to other factors.
E. The client's eyes are sensitive to light is incorrect; photophobia is not a direct indicator of liver damage and is more related to other conditions.
When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:
A. A return to normal respiratory rate, rhythm, and depth.
A return to normal respiratory rate, rhythm, and depth is correct because opioid antagonists, such as naloxone, are primarily used to reverse the respiratory depression caused by opioid overdose.
B. Management of alcohol withdrawal symptoms.
Management of alcohol withdrawal symptoms is incorrect; opioid antagonists do not address alcohol withdrawal.
C. A reduction in the client's rating of their pain.
A reduction in the client's rating of their pain is incorrect; opioid antagonists counteract the effects of opioids, which can result in increased pain levels rather than reduction.
D. Alertness and improve memory function.
Alertness and improve memory function is incorrect; while opioid antagonists may improve alertness by reversing sedation, the primary goal focuses on restoring respiratory function.
Full Explanation
A. A return to normal respiratory rate, rhythm, and depth is correct because opioid antagonists, such as naloxone, are primarily used to reverse the respiratory depression caused by opioid overdose.
B. Management of alcohol withdrawal symptoms is incorrect; opioid antagonists do not address alcohol withdrawal.
C. A reduction in the client's rating of their pain is incorrect; opioid antagonists counteract the effects of opioids, which can result in increased pain levels rather than reduction.
D. Alertness and improve memory function is incorrect; while opioid antagonists may improve alertness by reversing sedation, the primary goal focuses on restoring respiratory function.