Nokea
A 42-year-old female highway construction worker is concerned about her cancer risks. She reveals that she has been married for 18 years, has two children, smokes one pack of cigarettes per day, and drinks one to two beers with her husband after work almost every day. She is 30 lb overweight, eats fast food often, and rarely eats fresh fruits and vegetables. Her mother was diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What combination of behavioral changes should the nurse instruct this client to make first?
- A. Decrease fat in the diet, decrease alcohol consumption, and use sunscreen every day.
- B. Decrease intake of salt-cured food, lose weight, and stop smoking.
- C. Stop drinking beer, decrease fiber in the diet, and use sun protection.
- D. Stop smoking, use sun protection, and lose weight.
Correct Answer: D
Rationale: Stopping smoking, using sun protection, and losing weight address the most critical modifiable risk factors for this client, given her smoking history, prior skin cancer, and obesity, which are linked to multiple cancers.
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The nurse is teaching a client about a newly prescribed doxycycline. Which of the following statements, if made by the client, would require further teaching? Select all that apply.
- A. I should take this medication with milk or cheese.
- B. If I develop foul-smelling diarrhea I should contact my doctor.
- C. I need to wear sunscreen outdoors while taking this medication.
- D. I can stop this medication when I feel better.
- E. I should take this medication on an empty stomach.
Correct Answer: A,D
Rationale: Doxycycline should not be taken with dairy products like milk or cheese (Choice A) because calcium can bind to the medication and reduce its absorption. Choice D is incorrect because antibiotics like doxycycline should be taken for the full prescribed course to prevent resistance and ensure complete treatment. Choice B is correct; foul-smelling diarrhea could indicate a serious infection like Clostridium difficile. Choice C is correct; doxycycline causes photosensitivity, requiring sunscreen. Choice E is correct; taking doxycycline on an empty stomach improves absorption.
The most appropriate suggestion for the hospice nurse to give a woman whose husband died 3 months ago and her three young children would be to:
- A. Seek group counseling support for the three children.
- B. Request individual counseling and medication to manage depression.
- C. Remind her gently that bereavement care before the child's effective grieving.
- D. Continue her bereavement support through hospice.
Correct Answer: D
Rationale: Continuing bereavement support through hospice provides ongoing emotional support for the woman and her children, tailored to their needs during grief.
A client is scheduled for an elective splenectomy. Immediately before the client goes to surgery, the nurse should determine that the client has:
- A. Voided completely.
- B. Signed the consent.
- C. Vital signs recorded.
- D. Name band on wrist.
Correct Answer: B
Rationale: Verifying that the client has signed the consent form is the priority before surgery to ensure informed consent and legal compliance. Voiding, recording vital signs, and checking the name band are also important but secondary to consent verification.
A client is admitted on the day of surgery for an arthroscopy of the left knee. Which nursing activities should be completed to avoid wrong-site surgery? Select all that apply.
- A. Ask the surgeon preoperatively to mark with a permanent marker the correct knee for the surgical site.
- B. Verbally ask the client to state his name, surgical site, and procedure.
- C. Verify the correct client with the correct operative site by medical records and radiographic diagnostic reports.
- D. Call a 'time-out' in the operating room to have the surgeon verify the correct knee before making the incision.
- E. Show the client an anatomic model of the surgery site.
Correct Answer: A,B,C,D
Rationale: To prevent wrong-site surgery, the surgeon marks the site (A), the client verifies identity and procedure (B), records are checked (C), and a time-out confirms the site (D). Showing a model (E) is educational but not a standard safety measure.
A Stage II pressure ulcer is characterized by:
- A. Redness in the involved area.
- B. Muscle spasms in the involved area.
- C. Pain in the involved area.
- D. Tissue necrosis in the involved area.
Correct Answer: C
Rationale: Stage II pressure ulcers cause pain due to partial-thickness skin loss and exposed nerve endings. Redness is Stage I, and necrosis is Stage III or IV.