Nokea
A client who had a total knee replacement with a metal prosthesis is being prepared for discharge to home. Which statement by the client indicates to the nurse a need for further teaching?
- A. I can expect that changes in the shape of the knee will occur.
- B. I need to tell any future caregivers about the metal prosthesis.
- C. I need to report bleeding gums or tarry stools to the primary health care provider.
- D. I need to report fever, redness, or increased pain to the primary health care provider.
Correct Answer: A
Rationale: After a total knee replacement, the client should be taught to report any changes in the shape of the knee. This is not an expected event during recuperation from surgery. The client must notify caregivers of the metal implant because the client will need antibiotic prophylaxis for invasive procedures, and will be ineligible for magnetic resonance imaging as a diagnostic procedure. With a metal prosthesis, the client must be on anticoagulant therapy and should report adverse effects of this therapy, such as evidence of bleeding from a variety of sources. Fever, redness, or increased pain may indicate infection.
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What are the nursing implications associated with administering blood and blood products to a client who has a blood type of B negative?
- A. The nurse must be knowledgeable about the fact that this client has A and B agglutinins and lacks the Rh factor
- B. The nurse must be knowledgeable about the fact that this client has B and O agglutinins and lacks the Rh factor
- C. The nurse must be knowledgeable about the fact that this client has B agglutinins and lacks the Rh factor
- D. The nurse must be knowledgeable about the fact that this client has A agglutinins and lacks the Rh factor
Correct Answer: C
Rationale: B negative blood type has anti-A agglutinins (antibodies against A antigen) and lacks the Rh factor, requiring careful matching to avoid transfusion reactions.
The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is:
- A. Decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels
- B. Decreased TSH and increased T4 levels
- C. Decreased creatine phosphokinase levels
- D. Absence of antithyroid antibodies
Correct Answer: A
Rationale: Hypothyroidism is characterized by decreased thyroxine (T4) and increased TSH as the pituitary attempts to stimulate the thyroid. Other options are inconsistent with hypothyroidism.
The nurse reviews the client's health care record and notes that the client is taking donepezil hydrochloride. Understanding the purpose of this medication, the nurse suspects this client has which medical problem?
- A. Dementia
- B. Seizure disorder
- C. History of schizophrenia
- D. Obsessive-compulsive disorder
Correct Answer: A
Rationale: Donepezil hydrochloride is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer's type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. None of the remaining options are conditions that are treated with this medication.
An infant is born with facial abnormalities, growth retardation, mental retardation, and vision abnormalities. These abnormalities are probably caused by maternal:
- A. Alcohol consumption.
- B. Vitamin B6 deficiency.
- C. Vitamin A deficiency.
- D. Folic acid deficiency.
Correct Answer: A
Rationale: These symptoms are characteristic of fetal alcohol syndrome, caused by maternal alcohol consumption during pregnancy, which affects fetal development.
A client is diagnosed with a flail chest. Which characteristics related to breathing should the nurse observe for in the client?
- A. Cyanosis and slow respirations
- B. Slight bradypnea with shallow breaths
- C. Pallor and paradoxical chest movement
- D. Severe dyspnea and paradoxical chest movement
Correct Answer: D
Rationale: The client with flail chest is in obvious respiratory distress. The client has severe dyspnea and cyanosis accompanied by paradoxical chest movement. Respirations are shallow, rapid, and grunting in nature.