Nokea
A client who is recovering from transurethral resection of the prostate (TURP) experiences urinary incontinence. He tells the nurse that he has decreased his fluid intake because of the incontinence. What would be the nurse's best response to the client?
- A. Yes, limiting your fluids can decrease your incontinence.'
- B. Limiting your fluids will cause kidney stones.'
- C. I think eight glasses of water a day and urinate every 2 hours.'
- D. If your incontinence continues, we will reinsert your catheter.'
Correct Answer: C
Rationale: Encouraging adequate fluid intake (eight glasses) and scheduled voiding (every 2 hours) helps manage incontinence and maintain urinary health post-TURP.
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The nurse is administering epoetin alfa to a client diagnosed with chronic kidney disease (CKD). For which adverse effect of this therapy should the nurse monitor the client?
- A. Anemia
- B. Hypertension
- C. Iron intoxication
- D. Bleeding tendencies
Correct Answer: B
Rationale: The client taking epoetin alfa is at risk of hypertension and seizure activity as the most serious adverse effects of therapy. This medication is used to treat anemia. The medication does not cause iron intoxication. Bleeding tendencies is not an adverse effect of this medication.
The nurse is caring for a young adult client diagnosed with sarcoidosis. The client is angry and tells the nurse that there is no point in learning disease management because there is no possibility of ever being cured. Based on the client's statement, the nurse determines that the client is experiencing which potential problem?
- A. Apprehension
- B. Powerlessness
- C. Intellectualization
- D. Ineffective thought process
Correct Answer: B
Rationale: The client with powerlessness expresses feelings of having no control over a situation or outcome. Apprehension is fearful or uneasy anticipation of something. Intellectualization is excessive reasoning to avoid feeling. Ineffective thought process involves interruption in normal thought.
The nurse is teaching a client with a new diagnosis of atrial fibrillation about dabigatran (Pradaxa). Which of the following instructions is most important?
- A. Take the medication with food to reduce stomach upset.
- B. Report any signs of bleeding immediately.
- C. Avoid taking the medication with aspirin.
- D. Store the medication in the refrigerator.
Correct Answer: B
Rationale: Dabigatran, an anticoagulant, increases bleeding risk, so reporting signs of bleeding is critical for safety.
The nurse is teaching a client about the modifiable risk factors that can reduce the risk for colorectal cancer. The nurse places priority on discussing which risk factor with this client?
- A. Age older than 30 years
- B. High-fat and low-fiber diet
- C. Distant relative with colorectal cancer
- D. Personal history of ulcerative colitis or gastrointestinal polyps
Correct Answer: B
Rationale: Clients should be aware of modifiable risk factors as part of general health maintenance and primary disease prevention. Modifiable risk factors are those that can be reduced and include a high-fat and low-fiber diet. Common risk factors for colorectal cancer that cannot be changed include age older than 40 years, first-degree relative with colorectal cancer, and history of bowel problems such as ulcerative colitis or familial polyposis.
A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse monitors the client for relief of which symptom?
- A. Flatus
- B. Heartburn
- C. Rectal pain
- D. Muscle twitching
Correct Answer: B
Rationale: Calcium carbonate is used as an antacid for the relief of heartburn and indigestion. It can also be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with renal failure. The remaining options are unrelated to this medication.