Nokea
A client is admitted for suspected bladder cancer. Which one of the following factors is most significant in the client's diagnosis?
- A. Smoking a pack of cigarettes a day for 30 years
- B. Use of nonsteroidal anti-inflammatories
- C. Eating foods with preservatives
- D. Past employment involving asbestos
Correct Answer: A
Rationale: Long-term smoking is a major risk factor for bladder cancer due to carcinogenic chemicals in tobacco being excreted in urine, irritating the bladder.
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The nurse is reviewing the lab reports on several clients. Which one should be reported to the physician immediately?
- A. A serum creatinine of 5.2 mg/dL in a client with chronic renal failure
- B. A positive C reactive protein in a client with rheumatic fever
- C. A hematocrit of 52% in a client with gastroenteritis
- D. A white cell count of 2,200 cu/mm in a client taking Dilantin phenytoin
Correct Answer: D
Rationale: A white cell count of 2,200 cu/mm indicates severe leukopenia, a serious side effect of Dilantin, requiring immediate reporting.
The physician orders an MRI of the spine with infusion for an adult female. Which of the following findings in the client's history should the nurse report to the physician?
- A. allergy to shellfish
- B. congestive heart failure (CHF)
- C. chronic cystitis
- D. metformin administered daily
Correct Answer: A
Rationale: Shellfish allergy may indicate iodine sensitivity, a concern for MRI contrast, requiring physician evaluation to prevent allergic reactions.
The nurse is assessing a client following a coronary artery bypass graft (CABG). The nurse should give priority to reporting:
- A. Chest drainage of 150 mL in the past hour
- B. Confusion and restlessness
- C. Pallor and coolness of skin
- D. Urinary output of 40 mL per hour
Correct Answer: B
Rationale: Confusion and restlessness may indicate cerebral hypoxia or other serious complications post-CABG, requiring immediate reporting.
The client is admitted following repair of a fractured tibia and cast application. Which nursing assessment should be reported to the doctor?
- A. Pain beneath the cast
- B. Warm toes
- C. Pedal pulses weak and rapid
- D. Paresthesia of the toes
Correct Answer: C
Rationale: Weak and rapid pedal pulses suggest compromised circulation, which requires immediate reporting to prevent complications like compartment syndrome.
The nurse is making initial rounds on a client with a C5 fracture. The client is in a halo vest and is receiving O2 at 40% via mask to a tracheostomy. Assessment reveals a respiratory rate of 40 and O2 saturation of 88. The client is restless. Which initial nursing action is most indicated?
- A. Notifying the physician
- B. Performing tracheal suctioning
- C. Repositioning the client to the left side
- D. Rechecking the client's O2 saturation
Correct Answer: B
Rationale: Restlessness, tachypnea, and low O2 saturation suggest airway obstruction or secretions. Tracheal suctioning is the initial action to clear the airway and improve oxygenation.