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NEW QUESTION # 497
A male client tells his nurse that he has had an ulcer in the past and is afraid it is "flaring up again." The nurse begins to ask him specific questions about his symptoms. The nurse knows that a symptom that might indicate a serious complication of an ulcer is:
- A. Melena
- B. A bowel movement every 3-5 days
- C. Pain in the middle of the night
- D. Episodes of nausea and vomiting
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Clients with ulcers generally experience abdominal pain. It is common to have pain in the early morning hours with an ulcer. (B) Constipation is not a symptom associated with ulcers and would indicate a need to look at other factors. (C) Melena is blood in the stools. This could indicate a slow bleeding ulcer, which could result in significant amounts of blood loss over time.(D) Nausea and vomiting may be present as a result of the ulcer, especially if it is a gastric ulcer. This does not indicate an immediate life-threatening complication.
NEW QUESTION # 498
A female client was employed as a client care technician in a hemodialysis unit. She recently began to experience extreme fatigue, being able to sleep for 16-20 hours at a time. She also noted that her urine was tea colored, which she rationalized was a result of the vitamins she began taking to alleviate fatigue. She was diagnosed with hepatitis B.
After a brief hospital stay, she is discharged to her parent's home. Her mother asks the nurse if any precautions are necessary to prevent transmission to the client's family. The nurse explains necessary precautions, which include:
- A. Separate bathroom facilities if possible; if not, then cleansing daily of the facilities with a chloride solution
- B. Isolation of the client from the remainder of the family
- C. Laundering clothes separately in cold water with a chloride solution
- D. No necessary precautions because she is beyond the contagious phase
Answer: A
Explanation:
(A) Isolation is not necessary, even in the acute phase. (B) Separate bathroom facilities are recommended. If unavailable, daily cleansing with a chloride solution is recommended. (C) Precautions continue to be necessary while the client is in the active phase of hepatitis. (D) Clothes are to be laundered separately in hot water with a chloride solution.
NEW QUESTION # 499
A client has returned to the unit from the recovery room after having a thyroidectomy. The nurse knows that a major complication after a thyroidectomy is:
- A. Respiratory obstruction
- B. Fistula formation
- C. Hypercalcemia
- D. Myxedema
Answer: A
Explanation:
Explanation
(A) Respiratory obstruction due to edema of the glottis, bilateral laryngeal nerve damage, or tracheal compression from hemorrhage is a major complication after a thyroidectomy. (B) Hypocalcemia accompanied by tetany from accidental removal of one or more parathyroid glands is a major complication, not hypercalcemia. (C) Fistula formation is not a major complication associated with a thyroidectomy. It is a major complication with a laryngectomy.(D) Myxedema is hypothyroidism that occurs in adults and is not a complication of a thyroidectomy. A thyroidectomy client tends to develop thyroid storm, which is excess production of thyroid hormone.
NEW QUESTION # 500
A male client is admitted to the psychiatric unit after experiencing severe depression. He states that he intends to kill himself, but he asks the nurse not to repeat his intentions to other staff members. Which response demonstrates understanding and appropriate action on the part of the nurse?
- A. "Don't do that, you have so much to live for. You have a wonderful wife and children. The client in the next room has no one."
- B. "This is very serious. I do not want any harm to come to you. I will have to report this to the rest of the staff."
- C. "We need to discuss this further, but right now let's complete these forms."
- D. "I understand you're depressed, but killing yourself is not a reasonable option."
Answer: B
Explanation:
Explanation
(A) To the client, suicide may be a reasonable action and the only one he can cope with at this time. (B) This response indicates to the client that his intention to commit suicide is not important to the nurse at this time.
(C) The client is so depressed that he is not able to see the positive aspects of his life. At no time should the nurse discuss another client's problems in conversation. (D) This statement tells the client that the nurse recognizes his problem is of a serious nature and will take all steps necessary to help him.
NEW QUESTION # 501
A 17-year-old pregnant client who is gravida 1, para 0, is at 36 weeks' gestation. Based on the nurse's knowledge of the maternal physiological changes in pregnancy, which of these findings would be of concern?
- A. Hematocrit 39%
- B. Complaints of dyspnea
- C. Edema of face and hands
- D. Pulse of 65 bpm at 8 weeks, 73 bpm at 36 weeks
Answer: C
Explanation:
Explanation
(A) Dyspnea is a common complaint during the third trimester owing to the increasing size of the uterus and the resulting pressure against the diaphragm. (B) Edema of the face, hands, or pitting edema after 12 hours of bed rest may be indicative of preeclampsia and would be of great concern to the healthcare provider. (C) An increase in heart rate of 10-15 bpm is a normal physiological change in pregnancy due to the multiple hemodynamic changes. (D) A hematocrit value of 39% is within the normal range. A value <35% would indicate anemia.
NEW QUESTION # 502
The nurse would assess the client's correct understanding of the fertility awareness methods that enhance conception, if the client stated that:
- A. "My sexual partner and I should have intercourse when my cervical mucosa is thick and cloudy."
- B. "I should douche immediately after intercourse."
- C. "At ovulation, my basal body temperature should rise about 0.5F."
- D. "My sexual partner and I should have sexual intercourse on day 14 of my cycle regardless of the length of the cycle."
Answer: C
Explanation:
(A)
At ovulation, the cervical mucus is increased, stretchable, and watery clear. (B) Under the influence of progesterone, the basal body temperature increases slightly after ovulation.
(C)
To enhance fertility, measures should be taken that promote retention of sperm rather than removal. (D) Ovulation, the optimal time for conception, occurs 14+2 days before the next menses; therefore, the date of ovulation is directly related to the length of the menstrual cycle.
NEW QUESTION # 503
A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours' duration. After physical examination and obtaining the client's history, the physician suspects urethral obstruction by calculi. The nurse realizes that the physician will order which one of the following diagnostic studies to best confirm the diagnosis?
- A. Cystoscopy
- B. Ureterolithotomy
- C. Kidneys, ureter, bladder, x-ray of abdomen
- D. Intravenous pyelogram with excretory urogram
Answer: D
Explanation:
(A) Cystoscopy is an endoscopic procedure that uses an instrument (a cystoscope) to visualize the internal bladder and ureter structures and to capture and remove an obstructing stone. (B) Kidney, ureter, bladder x-ray is used to outline gross structural changes in the kidneys, ureter, and bladder and will determine the general location of a stone. (C) An intravenous pyelogram with excretory urogram is used to visualize the kidneys, kidney pelvis, ureters, and bladder. This procedure is used specifically to determine whether urethral obstruction is partial or complete; it shows the exact location of the stone and dilation of the ureter above the stone. (D) Ureterolithotomy is a surgical procedure in which the ureter is incised and the stone is manually removed because the stone is unable to pass through the ureter independently.
NEW QUESTION # 504
Assessment of a newborn for Apgar scoring includes observation for:
- A. Pupil response
- B. Heart rate
- C. Respiratory rate
- D. Babinski's reflex
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Pupil response should be assessed but is not part of Apgar scoring. (B) Respiratory effort is an essential part of Apgar scoring, not respiratory rate. (C) Heart rate is the most critical component of Apgar scoring. (D) Assessment of Babinski's reflex is not a component of Apgar scoring.
NEW QUESTION # 505
Provide the 1-minute Apgar score for an infant born with the following findings:
* Heart rate: Above 100
* Respiratory effort: Slow, irregular
* Muscle tone: Some flexion of extremities
* Reflex irritability: Vigorous cry Color: Body pink, blue extremities
- A. 0
- B. 1
- C. 2
- D. 3
Answer: D
Explanation:
Section: Questions Set A
Explanation:
(A) Seven out of a possible perfect score of 10 is correct. Two points are given for heart rate above 100; 1 point is given for slow, irregular respiratory effort; 1 point is given for some flexion of extremities in assessing muscle tone; 2 points are given for vigorous cry in assessing reflex irritability; 1 point is assessed for color when the body is pink with blue extremities (acrocyanosis). (B) For a perfect Apgar score of 10, the infant would have a heart rate over 100 but would also have a good cry, active motion, and be completely pink. (C) For an Apgar score of 8 the respiratory rate, muscle tone, or color would need to fall into the 2-point rather than the 1-point category. (D) For this infant to receive an Apgar score of 9, four of the areas evaluated would need ratings of 2 points and one area, a rating of 1 point.
NEW QUESTION # 506
Assessment of parturient reveals the following: cervical dilation 6 cm and station 22; no progress in the last 4 hours. Uterine contractions decreasing in frequency and intensity. Marked molding of the presenting fetal head is described. The physician orders, "Begin oxytocin induction at 1 mU/min." The nurse should:
- A. Increase the dosage by 2 mU/min increments at15-minute intervals
- B. Question the order
- C. Maintain the dosage when duration of contractions is 40-60 seconds and frequency is at 212-4 minute intervals
- D. Begin the oxytocin induction as ordered
Answer: B
Explanation:
Explanation
(A) Oxytocin stimulates labor but should not be used until CPD (cephalopelvic disproportion) is ruled out in a dysfunctional labor. (B) This answer is the correct protocol for oxytocin administration, but the medication should not be used until CPD is ruled out. (C) This answer is the correct manner to interpret effective stimulation, but oxytocin should not be used until CPD is ruled out. (D) This answer is the appropriate nursing action because the scenario presents adysfunctional labor pattern that may be caused by CPD. Oxytocin administration is contraindicated in CPD.
NEW QUESTION # 507
In the client with a diagnosis of coronary artery disease, the nurse would anticipate the complication of bradycardia with occlusion of which coronary artery?
- A. Left anterior descending coronary artery
- B. Right coronary artery
- C. Circumflex coronary artery
- D. Left main coronary artery
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Sinus bradycardia and atrioventricular (AV) heart block are usually a result of right coronary artery occlusion. The right coronary artery perfuses the sinoatrial and AV nodes in mostindividuals. (B) Occlusion of the left main coronary artery causes bundle branch blocks and premature ventricular contractions. (C) Occlusion of the circumflex artery does not cause bradycardia. (D) Sinus tachycardia occurs primarily with left anterior descending coronary artery occlusion because this form of occlusion impairs left ventricular function.
NEW QUESTION # 508
The nurse is notified that a 27-year-old primigravida diagnosed with complete placenta previa is to be admitted to the hospital for a cesarean section. The client is now at 36 weeks' gestation and is presently having bright red bleeding of moderate amount. On admission, the nursing intervention that the nurse should give the highest priority to is:
- A. Start an IV infusion in the client's arm
- B. Insert an indwelling catheter into her bladder
- C. Determine the status of the fetus by fetal heart tones
- D. Shave the client's abdomen and arrange her lab work
Answer: C
Explanation:
(A) These nursing actions are necessary prior to the cesarean section, but not immediately necessary to maintain physiological equilibrium. (B) Determining the physiological status of the fetus would constitute the highest priority in evaluating and maintaining fetal life. (C) These nursing actions are necessary prior to the cesarean section, but not immediately necessary to maintain physiological equilibrium. (D) These nursing actions are necessary prior to the cesarean section, but not immediately necessary to maintain physiological equilibrium.
NEW QUESTION # 509
An 80-year-old male client with a history of arteriosclerosis is experiencing severe pain in his left leg that started approximately 20 minutes ago. When performing the admission assessment, the nurse would expect to observe which of the following:
- A. The left leg warmer to touch than the right leg
- B. Both lower extremities warm to touch with 2_pedal pulses
- C. Both lower extremities cyanotic when placed in a dependent position
- D. Decreased or absent pedal pulse in the left leg
Answer: D
Explanation:
Section: Questions Set G
Explanation:
(A) This statement describes a normal assessment finding of the lower extremities. (B) This assessment finding reflects problems caused by venous insufficiency. (C) Decreased or absentpedal pulses reflect a problem caused by arterial insufficiency. (D) The leg that is experiencing arterial insufficiency would be cool to touch due to the decreased circulation.
NEW QUESTION # 510
A baby is circumcised. Immediate postoperative care should include:
- A. Taking the baby to his mother for cuddling
- B. Applying a loose diaper
- C. Keeping the baby NPO for 4 hours to avoid vomiting
- D. Changing the dressing frequently using dry, sterile gauze
Answer: A
Explanation:
Explanation
(A) A pressure diaper should be applied to discourage hemorrhage. (B) The baby can be fed by his mother soon after the procedure, once it is assessed that he is not in any distress and is stable. (C) Dressing changes should not be dry. Dry dressing will stick. (D) Cuddling after the procedure will hopefully quiet the baby.
Feeding is also important if his feeding was withheld prior to the procedure or it is time for a feeding.
NEW QUESTION # 511
A 40-year-old client is admitted to the coronary care unit with chest pain and shortness of breath. The physician diagnosed an anterior wall myocardial infarction.
What tests should the nurse anticipate?
- A. Lactic dehydrogenase, CPK
- B. Sedimentation rate, WBC count
- C. Reticulocyte count, creatinine phosphokinase (CPK)
- D. Aspartate transaminase, alanine transaminase
Answer: A
Explanation:
Explanation
(A) Reticulocyte count measures the number of immature erythrocytes. CPK is an enzyme released from injured myocardial tissue. (B) Aspartate transaminase is an enzyme released from injured myocardial tissue.
Alanine transaminase is an enzyme released for general tissue destruction, which is specific for liver injury.
(C) Sedimentation rate is a nonspecific test for inflammation. (D) Lactic dehydrogenase and CPK are enzymes released from injured myocardial tissue.
NEW QUESTION # 512
A 22-year-old single woman was admitted to the psychiatric hospital by her mother, who reported bizarre behavior. Except for going to work, she spends all her time in her room and expresses concern over neighbors spying on her. She has fears of the telephone being "bugged." Her diagnosis is schizophrenia. One nurse per shift is assigned to work with the client. The primary reason for this plan would be to:
- A. Enable her to develop trust
- B. Supervise her medication regimen
- C. Involve her in groups for social interaction
- D. Protect her from suicide
Answer: A
Explanation:
(A) Suicide is a greater risk in depression than in schizophrenia. (B) The client is suspicious and needs help to develop trust, which is basic to her improvement. (C) Although she will be taking medication, drug therapy would not necessitate consistency in the nurses assigned. (D) A suspicious client should have limited exposure to groups, because group participation increases discomfort.
NEW QUESTION # 513
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