Nokea
A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?
- A. Encourage regular visitors to boost morale.
- B. Ensure the client receives live vaccines.
- C. Place the client in a private room.
- D. Provide a diet high in fresh fruits and vegetables.
Correct Answer: C
Rationale: The correct answer is C: Place the client in a private room. This is important to reduce the risk of infection for the client with neutropenia, as being in a private room minimizes exposure to pathogens from other individuals. Neutropenia is a condition where there is a low level of neutrophils, a type of white blood cell that helps fight infections. By placing the client in a private room, the nurse can control the environment and limit the client's exposure to potential sources of infection.
Choice A is incorrect because regular visitors may introduce pathogens that could increase the client's risk of infection. Choice B is incorrect as live vaccines are contraindicated in clients receiving chemotherapy due to their weakened immune system. Choice D is incorrect because while fresh fruits and vegetables are important for overall health, in this case, the risk of infection outweighs the benefits of a diet high in these foods.
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A client diagnosed with dementia is disoriented, wandering, has a decreased appetite, and is having trouble sleeping. What is the priority nursing problem for this client?
- A. Disturbed thought processes.
- B. Altered sleep pattern.
- C. Imbalanced nutrition: less than.
- D. Risk for injury.
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. The client's symptoms of disorientation, wandering, decreased appetite, and difficulty sleeping indicate an increased risk for falls, accidents, or getting lost. Ensuring the client's safety and preventing any potential harm is the priority.
A: Disturbed thought processes may contribute to the client's disorientation but do not pose an immediate threat to their safety.
B: Altered sleep pattern is concerning but is secondary to the risk of injury in this scenario.
C: Imbalanced nutrition: less than is important, but the immediate priority is addressing the client's safety due to the risk of injury.
In summary, the priority nursing problem for this client is the risk for injury due to their disorientation and wandering behavior, which could lead to accidents or harm.
A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: B
Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate an overactive thyroid gland, leading to symptoms like fatigue, weight gain, and constipation. The low TSH is due to negative feedback as the high free T4 suppresses TSH production. Hyperthyroidism fits this clinical picture, as opposed to hypothyroidism (choice A) which would have high TSH and low free T4 levels. Thyroiditis (choice C) typically presents with symptoms of both hyperthyroidism and hypothyroidism and is usually transient. Thyroid cancer (choice D) is less likely given the presentation of symptoms and specific lab results.
A client with a history of myocardial infarction (MI) is prescribed nitroglycerin (Nitrostat) for chest pain. Which instruction should the nurse provide?
- A. Take the medication with food.
- B. Swallow the tablet whole.
- C. Take the medication at bedtime.
- D. Place the tablet under your tongue.
Correct Answer: D
Rationale: The correct answer is D: Place the tablet under your tongue. Nitroglycerin is a vasodilator used to relieve chest pain in patients with MI. Placing the tablet under the tongue allows for rapid absorption through the oral mucosa, providing quick relief. Taking it with food (A) may delay absorption. Swallowing the tablet whole (B) would result in slower absorption through the GI tract. Taking it at bedtime (C) is not necessary for immediate relief of chest pain.
An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?
- A. Prescribe an inexpensive NSAID alone
- B. Prescribe an inexpensive NSAID and misoprostol
- C. Prescribe celecoxib
- D. Prescribe an inexpensive NSAID and sucralfate
Correct Answer: A
Rationale: The correct answer is A: Prescribe an inexpensive NSAID alone. This option is the most appropriate because it balances the need for cost-effectiveness with the concern for peptic ulcers in an elderly patient. Starting with a simple NSAID reduces the risk of adverse effects and minimizes the financial burden on the patient. Option B adds misoprostol, which may help protect the stomach but increases the cost. Option C, prescribing celecoxib, is more expensive and carries a higher cardiovascular risk. Option D, adding sucralfate, does not have strong evidence for preventing NSAID-induced ulcers and adds unnecessary cost. Therefore, option A is the most suitable choice for this scenario.
A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?
- A. Hepatitis B
- B. Primary biliary cirrhosis
- C. Primary sclerosing cholangitis
- D. Autoimmune hepatitis
Correct Answer: C
Rationale: The most likely diagnosis is primary sclerosing cholangitis (PSC) based on the patient's symptoms of fatigue, pruritus, jaundice, and elevated bilirubin and alkaline phosphatase levels. PSC is commonly associated with inflammatory bowel disease, such as ulcerative colitis. The characteristic findings of elevated alkaline phosphatase and bilirubin levels are indicative of cholestasis, which is a key feature of PSC. Additionally, PSC is characterized by fibrosis and inflammation of the bile ducts, leading to bile duct strictures and subsequent liver damage. Hepatitis B would present with viral hepatitis symptoms and different lab findings. Primary biliary cirrhosis typically presents with elevated alkaline phosphatase and antimitochondrial antibodies. Autoimmune hepatitis would have elevated transaminases and autoantibodies. Therefore, based on the clinical presentation and lab results, PSC is the most likely diagnosis.