The client is being treated with Plavix. He complains to the nurse of experiencing chest pain. The highest priority nursing intervention is to call the physician because the client is experiencing a(n):
a. adverse reaction to the medication.
b. myocardial infarction.
c. expected side effect of the medication.
d. anaphylactic reaction to the medication.
ANS: C
Chest pain is an expected side effect of treatment with Plavix.
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As the nurse assesses the pregnant client, the client states that she sometimes feels like she has difficulty breathing. The client has reached the 36th week of her pregnancy
Which is the reason that the client is experiencing this phenomenon? 1. The fetus is pushing the diaphragm upwards. 2. Fatigue due to the pregnancy. 3. Anxiety about her impending delivery. 4. Contractions.
When collecting data related to the present illness, the nurse must obtain detailed and comprehensive data. What does this data help to establish?
a. A nursing diagnosis b. A nursing care plan c. Appropriate interventions d. Nursing orders
Anakinra (Kineret) is prescribed for a 49-year-old patient who has rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about
a. avoiding concurrently taking aspirin. b. symptoms of gastrointestinal (GI) bleeding. c. self-administration of subcutaneous injections. d. taking the medication with at least 8 oz of fluid.
A nurse is working with the family of a pediatric client. When planning to obtain an accurate family assessment, which initial step is the most appropriate?
1. Establish a trusting relationship with the family. 2. Select the most relevant family-assessment tool. 3. Focus primarily upon the mother, while learning her greatest concern. 4. Observe the family in the home setting, since this step always proves indispensable.