Nokea
A client post-cystoscopy is discharged. The nurse should instruct to:
- A. Resume normal activity.
- B. Avoid fluids for 24 hours.
- C. Expect blue urine.
- D. Take antibiotics for a week.
Correct Answer: A
Rationale: Normal activity can resume post-cystoscopy unless complications arise.
You may also like to solve these questions
The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PCO2 62; PO2 70; HCO3 34. The nurse should:
- A. Apply a 100% non-rebreather mask.
- B. Assess the vital signs.
- C. Reposition the client.
- D. Prepare for intubation.
Correct Answer: B
Rationale: The ABG shows compensated respiratory acidosis (normal pH, high PCO2, high HCO3) with mild hypoxemia (PO2 70). Assessing vital signs evaluates stability before escalating care. A non-rebreather mask or intubation is premature. Repositioning may help but is less urgent.
A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given I.V. The nurse should first:
- A. Administer the morphine.
- B. Obtain a 12-lead ECG.
- C. Obtain the blood work.
- D. Order the chest radiograph.
Correct Answer: A
Rationale: Administering morphine first relieves pain, reducing myocardial oxygen demand and stabilizing the client. ECG and blood work follow to confirm diagnosis, but pain management is the priority.
The nurse administers mannitol (Osmitrol) to the client with increased intracranial pressure. Which parameter requires close monitoring?
- A. Muscle relaxation.
- B. Intake and output.
- C. Widening of the pulse pressure.
- D. Pupil dilation.
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce ICP by drawing fluid from brain tissue. Monitoring intake and output is critical to assess its effectiveness and prevent dehydration or electrolyte imbalances. Muscle relaxation, pulse pressure, and pupil dilation are not directly related to mannitol's primary effects.
A client with detachment of the retina is to patch both eyes. The expected outcome of patching is to:
- A. Reduce rapid eye movements.
- B. Decrease the irritation caused by light entering the damaged eye.
- C. Protect the injured eye from infection.
- D. Rest the eyes to promote healing.
Correct Answer: A
Rationale: Patching both eyes reduces rapid eye movements, which could worsen retinal detachment by preventing further stress on the retina.
The nurse is assessing a 60-year-old male who has hoarseness. The nurse should conduct a focused assessment to determine:
- A. Patterns of medication use and history of alcohol consumption.
- B. Exposure to sun and family history of head and neck cancers.
- C. Exposure to wood dust and a high-fat diet.
- D. History of tobacco use and alcohol consumption.
Correct Answer: D
Rationale: Hoarseness in a 60-year-old male is concerning for head and neck cancers, particularly laryngeal cancer. A focused assessment should prioritize tobacco and alcohol use, as these are major risk factors.