a client has been prescribed albuterol which of the following is a priority adverse effect the nurse should monitor
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment 2020 A with NGN

1. A client has been prescribed albuterol. Which of the following is a priority adverse effect the nurse should monitor?

Correct answer: A

Rationale: Corrected Rationale: Albuterol, a beta-2 adrenergic agonist, can lead to tachycardia due to its stimulant effect on beta-2 receptors in the heart. Monitoring for tachycardia is crucial as it can be a sign of excessive sympathetic stimulation and may lead to severe complications. Bradycardia, dizziness, and hypertension are less likely adverse effects of albuterol, making them lower priority for monitoring in this context.

2. A nurse is caring for a newborn with hyperbilirubinemia. Which of the following interventions should be taken during phototherapy?

Correct answer: A

Rationale: During phototherapy for a newborn with hyperbilirubinemia, it is crucial to maintain an eye mask over the newborn's eyes. The purpose of the eye mask is to protect the infant's eyes from potential damage caused by the intense light used in phototherapy. While feeding the newborn frequently and monitoring temperature are essential aspects of newborn care, they are not specific to phototherapy. Administering vitamin K is important for newborns to prevent bleeding disorders but is not directly related to phototherapy for hyperbilirubinemia.

3. A nurse is caring for a newborn diagnosed with necrotizing enterocolitis (NEC). Which of the following interventions should the nurse expect to implement?

Correct answer: B

Rationale: Measuring abdominal girth is crucial in monitoring for signs of abdominal distension, which is a key indicator of worsening necrotizing enterocolitis (NEC). It helps in assessing the progression of the condition. Positioning the newborn supine, as in choice C, can help relieve pressure on the abdomen but does not directly monitor the condition. Applying cold compresses, as in choice D, is not recommended for NEC as it can constrict blood vessels and potentially worsen the condition. Withholding oral feedings, as in choice A, is also important to rest the bowel and prevent further complications, but measuring abdominal girth is more directly related to monitoring the progression of NEC.

4. A nurse is caring for a client with schizophrenia. Which of the following assessment findings should the nurse expect?

Correct answer: C

Rationale: Corrected Rationale: Poor problem-solving ability is a common cognitive symptom of schizophrenia. It affects the client's ability to think clearly and make decisions. Decreased level of consciousness (Choice A) is not a typical assessment finding in schizophrenia. Inability to identify common objects (Choice B) is more indicative of conditions like dementia. Preoccupation with somatic disturbances (Choice D) is characteristic of somatic symptom disorders, not schizophrenia.

5. When providing education on the use of insulin, what should be included?

Correct answer: B

Rationale: The correct answer is to monitor blood glucose levels before administration. This step is crucial to ensure the correct dose of insulin is administered based on the current blood glucose level. Choice A is incorrect as insulin usually needs to be stored in the refrigerator and has an expiration date. Choice C is incorrect because insulin can be short-acting, rapid-acting, intermediate-acting, or long-acting. Choice D is also incorrect as insulin can have side effects such as hypoglycemia if the dose is too high.

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