A client receives a cervical intracavity radium implant as part of her therapy. A common side effect of a cervical implant is:
- A. creamy, pink-tinged vaginal drainage.
- B. stomatitis.
- C. constipation.
- D. xerostomia.
Correct Answer: A
Rationale: Creamy, pink-tinged vaginal drainage persists for 1 to 2 months after removal of a cervical implant.
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A client is admitted with a diagnosis of Multiple Drug Use. The nurse should plan care based on knowledge that:
- A. Multiple drug use is very uncommon
- B. People might use more than one drug to enhance the effect or relieve withdrawal symptoms
- C. Alcohol and barbiturates used together are not dangerous because one is a stimulant and the other is a depressant
- D. Assessment and intervention are easier with multiple drug use because of the synergistic effect
Correct Answer: B
Rationale: Multiple drug use is common to enhance effects or relieve withdrawal symptoms, complicating assessment and intervention due to varied drug interactions.
Using clichés in therapeutic communication leads the client toward:
- A. viewing the nurse as human
- B. accepting himself as human
- C. self-disclosing
- D. feeling discounted
Correct Answer: D
Rationale: Clichés in communication can make clients feel dismissed or misunderstood, reducing trust and engagement in therapeutic interactions.
A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?
- A. Adaptation Model
- B. Stimulus-Based Model
- C. Transaction-Based Model
- D. Selye's Model of Stress
Correct Answer: C
Rationale: The Transaction-Based Model is, according to R.S. Lazarus, a state that Stimulus theory and Response theory do not consider individual differences. He takes into account cognitive processes that intervene between the encounter and the reaction and the factors that affect the nature of this process. He includes mental and psychological components or responses as part of his concept of stress (Person-Environment Transactions).
If a client is suffering from thyroid storm, the PN can expect to find on assessment:
- A. tachycardia and hyperthermia.
- B. bradycardia and hypothermia.
- C. a large goiter.
- D. a calm, quiet client.
Correct Answer: A
Rationale: In thyroid storm, excessive thyroxine causes increased metabolic rate, leading to tachycardia, hyperthermia, and other signs of hyperthyroidism such as atrial fibrillation.
A nurse observes a client sitting alone and talking. When asked, the client reports that he is 'talking to the voices.' The nurse's next action should be:
- A. touching the client to help him return to reality.
- B. leaving the client alone until reality returns.
- C. asking the client to describe what is happening.
- D. telling the client there are no voices.
Correct Answer: C
Rationale: Nurses might observe behavioral cues that can indicate the presence of hallucinations. Talking about the hallucinations is reassuring and validating to the client who has them. Focusing on the symptoms and asking about the hallucinations helps the client gain control.
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