Nokea
A client visits the clinic after the death of a parent. Which statement made by the client's sister signifies abnormal grieving?
- A. My sister still has episodes of crying, and it's been three months since Daddy died.
- B. Sally seems to have forgotten the bad things that Daddy did in his lifetime.
- C. She really had a hard time after Daddy's funeral. She said that she had a sense of longing.
- D. She has not been saddened at all by Daddy's death. She acts like nothing has happened.
Correct Answer: D
Rationale: Denial of grief, as indicated by acting like nothing has happened, suggests abnormal grieving, as it may reflect an inability to process the loss.
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The client is being evaluated for possible acute leukemia. Which inquiry by the nurse is most important?
- A. Have you noticed a change in sleeping habits recently?
- B. Have you had a respiratory infection in the last 6 months?
- C. Have you lost weight recently?
- D. Have you noticed changes in your alertness?
Correct Answer: C
Rationale: Unexplained weight loss is a common symptom of leukemia due to increased metabolic demand and systemic effects of the disease.
A client with angina is being discharged with a prescription for Transderm Nitro (nitroglycerin) patches. The nurse should tell the client to:
- A. Shave the area before applying the patch
- B. Remove the old patch and clean the skin with alcohol
- C. Cover the patch with plastic wrap and tape it in place
- D. Avoid cutting the patch because it will alter the dose
Correct Answer: B
Rationale: Removing the old patch and cleaning the skin with alcohol ensures proper adhesion and prevents irritation or overdose from residual medication.
The nurse is preparing to administer insulin to a client with type 1 diabetes mellitus. The client is to receive 10 units of regular insulin and 20 units of NPH insulin. Which of the following actions by the nurse is correct?
- A. Draw up the NPH insulin first, then the regular insulin in the same syringe.
- B. Administer the regular insulin in one syringe and the NPH in another.
- C. Mix the regular insulin with the NPH insulin in a vial before drawing it up.
- D. Administer the regular insulin 30 minutes after the NPH insulin.
Correct Answer: A
Rationale: regular insulin is drawn up first, followed by NPH, to prevent contamination of the regular insulin with NPH
The nurse is observing care given to a client experiencing severe to panic levels of anxiety. The nurse would intervene in which of the following situations?
- A. The staff maintains a calm manner when interacting with the client.
- B. The staff attends to client's physical needs as necessary.
- C. The staff helps the client identify thoughts or feelings that occurred prior to the onset of the anxiety.
- D. The staff assesses the client's need for medication or seclusion if other interventions have failed to reduce anxiety.
Correct Answer: C
Rationale: in this level of anxiety, client is unable to process thoughts and feelings for problem solving
A client with cocaine addiction would most likely be placed on which medication?
- A. Amantadine (Symmetrel)
- B. Methadone
- C. THC
- D. Disulfiram (Antabuse)
Correct Answer: A
Rationale: Amantadine is sometimes used to reduce cravings in cocaine addiction by modulating dopamine pathways, unlike the other options, which are used for different substance dependencies.