The nurse is caring for a patient who is scheduled to undergo a total knee replacement in two weeks. The nurse notes that the patient takes herbal supplements for the treatment of the patient's mental illness
What is the correct pre-surgical instruction the nurse will provide to the patient?
1. "You should continue the herbal supplements regardless of your surgery."
2. "You should discontinue the herbal supplements 2 weeks prior to your surgery."
3. "You should continue the herbal supplements if they do not interfere with your surgery."
4. "You should discontinue the herbal supplements 1 week prior to your surgery."
Answer: 2
Explanation: The nurse should advise the patient to discontinue the herbal supplements 2 weeks, not 1 week, prior to the surgery. It is incorrect to advise the patient to continue the herbal supplements regardless of the surgery, or to continue the supplements if they do not interfere with the surgery. The nurse must assume that the patient does not know whether the supplements will interfere with the patient's surgery.
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The nurse is preparing to assess the client's dorsalis pedis pulse. Which location will the nurse palpate to assess this pulse?
A. Lateral wrist.
B. Popliteal fossa.
C. Medial side of the dorsum of the foot.
D. Behind the medial malleolus.
The patient has serum drug levels of an antiepileptic drug ordered. The patient asks the nurse why drug levels are measured. What is the nurse's best response?
A) To evaluate whetherthe therapeutic range is reached B) To measure the amount of toxicity C) To determine the effect of the drug on body systems D) To evaluate the effectiveness of therapy
The nurse is caring for a client with dyspnea resulting from pulmonary edema secondary to congestive heart failure. The health care provider is notified, and the nurse receives a verbal order for Lasix 40 mg STAT
Which action by the nurse is the most appropriate? 1. Administer the medication immediately. 2. Clarify the route for administration. 3. Give the medication IV because the client is in distress and rapid effects are needed. 4. Hold the medication until the prescriber comes to the unit to clarify route and sign the order.
A patient with a tension pneumothorax requires insertion of a pleural chest tube. The nurse assists the physician as multiple doses of a local anesthetic are administered prior to tube insertion. Which observation by the nurse warrants immediate physician attention?
1. The patient's respiratory rate changes from 22 to 26 breaths per minute. 2. The patient complains of pain during anesthetic injections. 3. The patient's systolic blood pressure changes from 156 to 138 mmHg. 4. The patient's heart rate changes from 100 to 75 beats per minute.