Nokea
A client is diagnosed with genital herpes, (herpes simplex virus type 2, or HSV-2). The nurse should instruct the client that:
- A. Using occlusive ointments may decrease the pain from the lesions.
- B. Reducing stressful life events may decrease the incidence of herpetic outbreaks.
- C. There are no effective drug therapies to manage herpes symptoms.
- D. Herpes is transmitted to partners only when lesions are weeping.
Correct Answer: B
Rationale: Reducing stress can decrease herpes outbreaks, as stress is a known trigger. Occlusive ointments may worsen lesions, antiviral therapies are effective, and herpes can be transmitted asymptomatically.
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A client with a history of multiple sclerosis is admitted with muscle weakness. The nurse should include which of the following in the plan of care?
- A. Assist with activities of daily living.
- B. Restrict physical activity.
- C. Provide a high-carbohydrate diet.
- D. Limit fluid intake.
Correct Answer: A
Rationale: Assisting with activities of daily living supports safety and independence in multiple sclerosis.
The nurse identifies the type of presentation shown in the fi gure as which of the following?
- A. Frank breech.
- B. Compound breech.
- C. Complete breech.
- D. Incomplete breech.
Correct Answer: C
Rationale: For a complete breech, the buttocks present, the feet and legs are fl exed on the thighs, and the thighs are fl exed on the abdomen. For a frank breech, the buttocks present with the hips fl exed and the legs extended against the abdomen and chest. This is the most common type of breech presentation. For a compound breech, the buttocks present together with another part, such as a hand. This is a rare occurrence. For an incomplete breech, one or both feet or the knees extend below the buttocks. This can also be termed a single footling or double footling breech.
The nurse is caring for a client with a history of chronic bronchitis who is prescribed theophylline (Theo-Dur). Which of the following symptoms indicates theophylline toxicity?
- A. Bradycardia.
- B. Tachycardia.
- C. Hypotension.
- D. Weight loss.
Correct Answer: B
Rationale: Tachycardia is a sign of theophylline toxicity, indicating the need for immediate medical evaluation.
The mother of a 28-year-old client who is taking clozapine [Clozaril] states, 'Something is wrong. My son is drooling like a baby.' Which of the following responses by the nurse would be most helpful?
- A. I wonder if he's having an adverse reaction to the medicine.'
- B. Excess saliva is common with this drug; here's a paper cup for him to spit into.'
- C. Don't worry about it; this is only a minor inconvenience compared to its benefits.'
- D. I've seen this happen to other clients who are taking Clozaril.'
Correct Answer: B
Rationale: Excess salivation is a common side effect of clozapine. Providing a practical solution like a cup supports the client's comfort and addresses the mother's concern.
Two days after being placed in a cast for a fracture, the client suddenly develops chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for:
- A. Osteomyelitis.
- B. Compartment syndrome.
- C. Venous thrombosis.
- D. Fat embolism syndrome.
Correct Answer: D
Rationale: Chest pain, dyspnea, confusion, and fever suggest fat embolism syndrome, a complication of fractures, particularly within 48 hours.