Nokea
A client is admitted to the hospital with the diagnosis of Cushing's disease. The nurse should monitor the client's laboratory studies for which associated disorder?
- A. Hypokalemia
- B. Hyperglycemia
- C. Decreased plasma cortisol levels
- D. Low white blood cell (WBC) count
Correct Answer: B
Rationale: The client with adrenocorticosteroid excess experiences hyperglycemia, hyperkalemia, elevated plasma cortisol and adrenocorticotropic hormone (ACTH) levels, and an elevated WBC count. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids on the body.
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The home health nurse cares for an obese adult client. In the client's medical record, the nurse reads, 'The client has a sprained right ankle, has not exercised for more than 1 week, and has missed the last two physical therapy appointments.' The client says, 'I attend therapy for my ankle and I do my exercises three times a day.' Which response should the nurse use with the client?
- A. Show me the exercises that you perform in physical therapy.
- B. You will never heal if you skip the physical therapy sessions.
- C. Your progress sounds fine. Is more physical therapy scheduled?
- D. I see that you missed the last two physical therapy appointments.
Correct Answer: D
Rationale: In the correct option, the nurse employs the therapeutic communication technique of confrontation. Because the client is employing avoidance, the nurse presents the facts according to the medical record to assess the client's perspective without accusing, threatening, or humiliating the client about the missed physical therapy. By confronting, the nurse assists the client with problem-solving. Option 1 is potentially helpful when the client is complying with therapy. In option 2, the nurse provides an opinion and this statement admonishes the client for the behavior. In option 3, the nurse is nontherapeutic in giving approval and is mirroring the client's avoidance and passivity by not dealing directly with the problem of missed appointments.
The nurse is caring for a client who has been diagnosed with pernicious anemia. Which of the following statements by the client indicates an understanding of the treatment of pernicious anemia?
- A. I will need to increase my dietary intake of foods that are high in vitamin B12.'
- B. I will receive my first injection of vitamin B12 tomorrow, and I will return for a follow-up injection in 1 month.'
- C. I understand that the oral form of vitamin B12 is preferred because it is safer and less expensive than the injection form.'
- D. I will need to take vitamin B12 replacements for the rest of my life.'
Correct Answer: D
Rationale: Pernicious anemia requires lifelong vitamin B12 injections due to intrinsic factor deficiency, preventing absorption of dietary or oral B12.
A nurse is assessing an 82-year-old for depression, because of the client's age, the nurses' assessment should be guided by the fact that:
- A. Sadness of mood is usually present but it is masked by other symptoms.
- B. Impairment of cognition usually is not present.
- C. Psychosomatic tendencies do not tend to dominate.
- D. Antidepressant therapies are less effective in older adults.
Correct Answer: A
Rationale: In older adults, depression may present with atypical symptoms, such as somatic complaints or irritability, rather than overt sadness, which can mask the condition.
The nurse is preparing to start an I.V. infusion. Before inserting the needle into a vein, the nurse should apply a tourniquet to the client's arm to accomplish which of the following?
- A. Distend the veins.
- B. Stabilize the veins.
- C. Immobilize the arm.
- D. Occlude arterial circulation.
Correct Answer: A
Rationale: A tourniquet distends veins by restricting venous return, making them easier to access for I.V. insertion.
The nurse is caring for a client with a history of burns. Which of the following interventions should be included in the plan of care? Select all that apply.
- A. Monitor urine output.
- B. Administer tetanus prophylaxis.
- C. Provide psychological support.
- D. Restrict visitors to prevent infection.
- E. Apply cold compresses to burns.
Correct Answer: A, B, C
Rationale: Monitoring urine output, tetanus prophylaxis, and psychological support are essential. Visitors should be screened, not restricted, and cold compresses are contraindicated.