Nokea
A client diagnosed with refractory myasthenia gravis is told by the primary health care provider that plasmapheresis therapy is indicated. When the client asks the nurse to repeat the primary health care provider's reason for prescribing this treatment, the nurse should tell the client that this therapy will most likely improve which problem?
- A. Double vision
- B. Difficulty breathing
- C. Urinary incontinence
- D. Prickling sensation in the legs
Correct Answer: B
Rationale: Plasmapheresis is a process that separates the plasma from the blood elements so that plasma proteins that contain antibodies can be removed. It is used as an adjunct therapy in myasthenia gravis and may give temporary relief to clients with actual or impending respiratory failure. Usually 3 to 5 treatments are required. This therapy is not indicated for the reasons listed in any of the other options.
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Which of the following goals is most important for a client with acute pancreatitis?
- A. The client reports minimal pain.
- B. The client regains a normal pattern for bowel movements.
- C. The client limits alcohol intake to two to three drinks per week.
- D. The client maintains normal liver function.
Correct Answer: A
Rationale: Minimizing pain is the most important goal in acute pancreatitis to improve client comfort and recovery.
A client with a history of depression is prescribed duloxetine (Cymbalta). The nurse should instruct the client to report which of the following side effects immediately?
- A. Mild headache.
- B. Increased blood pressure.
- C. Nausea.
- D. Fatigue.
Correct Answer: B
Rationale: Duloxetine can cause increased blood pressure, requiring immediate reporting to prevent cardiovascular complications.
A client with chronic renal failure is receiving hemodialysis. Which dietary restriction should the nurse emphasize?
- A. Low-protein diet.
- B. High-sodium diet.
- C. Low-potassium diet.
- D. High-calcium diet.
Correct Answer: C
Rationale: A low-potassium diet is critical in chronic renal failure to prevent hyperkalemia, which can cause cardiac complications.
When cleaning the skin around an incision and drain site, which of the following procedures should the nurse follow?
- A. Clean the incision and drain site separately.
- B. Clean from the incision to the drain site.
- C. Clean from the drain site to the incision.
- D. Clean the incision and drain site simultaneously.
Correct Answer: A
Rationale: Cleaning separately prevents cross-contamination between the incision and drain site, reducing infection risk.
A client who has been recently diagnosed with unsuccessful immunodiffence (MIDS) inquires about hospice services. The nurse explains that hospice care is appropriate:
- A. For clients with an inevitable death within weeks to months
- B. For all clients with AIDS at any stage
- C. Only for clients with cancer
- D. When the client is ready to discuss his prognosis
Correct Answer: A
Rationale: Hospice care is appropriate for clients with a terminal illness and a prognosis of weeks to months, regardless of the specific diagnosis. It is not limited to cancer or all AIDS stages, nor solely based on readiness to discuss prognosis.