a nurse is caring for a client in preterm labor who is receiving magnesium sulfate by continuous iv infusion which of the following client findings in
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Nursing Elites

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PN ATI Capstone Proctored Comprehensive Assessment A

1. A nurse is caring for a client in preterm labor who is receiving magnesium sulfate by continuous IV infusion. Which of the following client findings indicates medication toxicity?

Correct answer: B

Rationale: A urine output of 20 mL per hour is low and indicates renal insufficiency, a sign of magnesium sulfate toxicity. The medication is excreted by the kidneys, so toxicity can occur if renal function declines. Blood glucose of 150 mg/dL is within normal range and not indicative of magnesium sulfate toxicity. A systolic blood pressure of 140 mm Hg is elevated but not specifically related to magnesium sulfate toxicity. A BUN level of 20 mg/dL is also within normal limits and not a sign of medication toxicity.

2. A healthcare provider is providing education on the use of clozapine. Which of the following should be included?

Correct answer: A

Rationale: Correct Answer: A nurse should include monitoring for agranulocytosis when educating a patient about clozapine. Clozapine is known to cause agranulocytosis, a potentially life-threatening decrease in white blood cells. This adverse effect requires close monitoring to detect it early. Choices B, C, and D are incorrect because clozapine is not a first-line treatment for most conditions, it is more commonly associated with weight gain rather than weight loss, and it is known to have a risk for metabolic syndrome.

3. A nurse is caring for a client who is in labor and has a diagnosis of group B streptococcus ß-hemolytic infection. Which of the following medications should the nurse plan to administer?

Correct answer: A

Rationale: Ampicillin is the correct choice for treating group B streptococcus infections in pregnant women during labor to prevent neonatal infection. Group B streptococcus is commonly treated with penicillin or ampicillin; therefore, choices B, C, and D are incorrect. Azithromycin is not the first-line treatment for group B streptococcus. Ceftriaxone is not the preferred antibiotic for this infection during labor. Acyclovir is an antiviral medication used for herpes simplex virus infections, not bacterial infections like group B streptococcus.

4. A nurse is teaching a client about the dietary management of irritable bowel syndrome (IBS). Which of the following instructions should the nurse include?

Correct answer: B

Rationale: The correct answer is B: 'Drink peppermint tea.' Peppermint tea can help relax the smooth muscles of the gastrointestinal tract, reducing symptoms of IBS, such as bloating and abdominal discomfort. Choices A, C, and D are incorrect. Decreasing fiber intake is not recommended for IBS management as fiber can help regulate bowel movements. Increasing foods high in fat can exacerbate symptoms of IBS, as high-fat foods can be harder to digest. Avoiding foods with gluten is more relevant for individuals with gluten sensitivity or celiac disease, not specifically for IBS management.

5. A healthcare professional is assessing a client for potential complications after surgery. Which of the following should the healthcare professional monitor for?

Correct answer: A

Rationale: Corrected Rationale: Decreased urine output can indicate renal complications or dehydration, which are common post-surgical complications. Monitoring urine output is crucial for detecting early signs of kidney dysfunction or fluid imbalances. Increased appetite, improved mobility, and normal temperature are not typical signs of immediate post-surgical complications and would not be the priority for monitoring in this case.

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