Nokea
A client tells the nurse that her biopsy results indicate that the cancer cells are well-differentiated. How should the nurse respond?
- A. Ask the client if the healthcare provider has given her any information about the classification of her cancer
- B. Tell the client that well-differentiated cancer cells usually have a poor prognosis.
- C. Reassure the client that the cancer is not serious.
- D. Encourage the client to seek a second opinion for confirmation of the diagnosis.
Correct Answer: A
Rationale: Well-differentiated cancer cells typically indicate a slower-growing tumor. Clarifying the client's understanding ensures accurate communication and emotional support.
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Abnormal coloration of the urine (in the absence of haematuria) may be due to:
- A. Consumption of beetroot
- B. Treatment with co-danthramer
- C. Phenylketonuria
- D. Acute intermittent porphyria
Correct Answer: A
Rationale: Beetroot can cause red urine. Co-danthramer, phenylketonuria, and porphyria can also cause abnormal urine color, but beetroot is a common cause.
An older male client with long-standing lung disease is admitted to the medical unit for treatment of pulmonary infection. In assessing for signs of increasing hypoxia, which action should the nurse include? (select all that apply)
- A. Monitor dryness of mucous membranes
- B. Check for changes in mentation
- C. Observe color of skin and nailbeds
- D. Note appearance of jugular veins
Correct Answer: B
Rationale: Changes in mentation, skin color, and breathing patterns are key indicators of hypoxia in clients with lung disease.
A client with Guillain-Barre syndrome has paralysis of all extremities and requires mechanical ventilation. The nurse observes that the client is not blinking. Which action should the nurse implement?
- A. Protect cornea with lubricant and eye shields
- B. Administer artificial tears every hour.
- C. Encourage the client to blink every 10 minutes.
- D. Keep the client's eyes closed with adhesive tape.
Correct Answer: A
Rationale: Lack of blinking increases the risk of corneal damage. Lubricants and eye shields prevent dryness and injury to the cornea.
Distal renal tubular acidosis:
- A. Is characterised by hypokalaemia
- B. May be primary or secondary
- C. Presents with growth failure in infancy
- D. Urinary pH is usually < 5
Correct Answer: B
Rationale: Distal renal tubular acidosis (RTA) can be either primary (inherited) or secondary (acquired due to other conditions), affecting acid excretion in the distal tubule.
Indications for surgical closure of a VSD include the following EXCEPT
- A. patients who cannot thrive
- B. patients whose symptoms cannot be controlled between 6 and 24 months
- C. patients with pulmonary vascular disease
- D. patients older than 2 years with a large VSD associated with a Qs ratio greater than 2:1
Correct Answer: C
Rationale: Surgical closure is not routinely indicated for all VSDs, especially if asymptomatic.