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A 62-year-old male client with prostate cancer is scheduled for a radical prostatectomy. He expresses concern about how the surgery will affect his sexual function. The nurse's best response is to:
- A. Explain that sexual function will not be affected.
- B. Discuss that erectile dysfunction is a possible side effect.
- C. Suggest that he avoid sexual activity post-surgery.
- D. Assure him that libido will return immediately after recovery.
Correct Answer: B
Rationale: Radical prostatectomy often affects the nerves responsible for erections, making erectile dysfunction a possible side effect. Discussing this honestly prepares the client for potential outcomes and management options.
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If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:
- A. Explaining how the old behavior leads to poor health.
- B. Withholding praise until the new behavior is well established.
- C. Rewarding the client whenever the acceptable behavior is performed.
- D. Instilling mild fear into the client to extinguish the behavior.
Correct Answer: C
Rationale: Positive reinforcement, such as rewarding adaptive behaviors, encourages the client to continue healthy habits. Fear or delayed praise is less effective for behavior modification.
What diet should be implemented for a client who is in the early stages of cirrhosis?
- A. High-calorie, high-carbohydrate.
- B. High-protein, low-fat.
- C. Low-fat, low-protein.
- D. High-carbohydrate, low-sodium.
Correct Answer: A
Rationale: A high-calorie, high-carbohydrate diet (A) supports energy needs in early cirrhosis. High-protein (B) may worsen encephalopathy. Low-fat, low-protein (C) is too restrictive. Low-sodium (D) is relevant for ascites, not early cirrhosis.
A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for? Select all that apply.
- A. Projectile vomiting.
- B. Significant abdominal distention.
- C. Copious diarrhea.
- D. Rapid onset of dehydration.
- E. Increased bowel sounds.
Correct Answer: A,B,D,E
Rationale: Small intestinal obstruction can cause projectile vomiting (A), abdominal distention (B), rapid dehydration (D) due to fluid loss, and increased bowel sounds (E) proximal to the obstruction. Copious diarrhea (C) is less likely as stool passage is blocked. CN: Physiological adaptation; CL: Analyze
The charge nurse on a hematology/oncology unit is reviewing the policy for using abbreviations with the staff. The charge nurse should emphasize which of the following about why dangerous abbreviations need to be eliminated? Select all that apply.
- A. To ensure efficient and accurate communication.
- B. To prevent medication errors.
- C. To ensure client safety.
- D. To make it easier for clients to understand the medication orders.
- E. To make data entry into a computerized health record easier.
Correct Answer: A,B,C
Rationale: Eliminating dangerous abbreviations ensures clear communication, prevents medication errors, and enhances client safety by reducing misinterpretations. Client understanding and data entry ease are secondary benefits.
The nurse reviews a client's medical history and identifies a diagnosis of presbycusis. The nurse should integrate which intervention in the care plan?
- A. Have educational materials in large print
- B. Provide an eye patch to the affected eye
- C. Request food be seasoned with herbs
- D. Move closer to the better-hearing ear
Correct Answer: D
Rationale: Presbycusis is age-related hearing loss, so moving closer to the better-hearing ear facilitates communication. Large print materials and eye patches address vision issues, and herb-seasoned food is unrelated.