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A client who took a camping vacation two weeks ago in a county with a tropical climate comes to the clinic describing vague symptoms and diarrhea for the past week. Which finding is most important for the nurse report to the healthcare provider?
- A. Weakness and fatigue
- B. Intestinal cramping
- C. Weight loss
- D. Jaundiced sclera
Correct Answer: D
Rationale: Jaundiced sclera indicates possible liver involvement, which could be due to a tropical disease such as hepatitis or leptospirosis.
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A male client with bilateral carpal tunnel syndrome reports to the nurse that the pain and tingling he is experiencing worsens at night. What client teaching should the nurse provide?
- A. Elevate the hands on two pillows at night
- B. Notify the healthcare provider as soon as possible
- C. Wear braces as both wrists during the night
- D. Apply cold compresses for 30 minutes before bedtime
Correct Answer: C
Rationale: Wearing wrist braces during the night helps prevent exacerbation of carpal tunnel syndrome symptoms.
Medical treatment of myasthenia gravis includes:
- A. Thymectomy
- B. Physostigmine
- C. Edrophonium
- D. Anticholinergic agents
Correct Answer: C
Rationale: Edrophonium: Edrophonium is used in the diagnosis and short-term treatment of myasthenia gravis as it improves neuromuscular transmission by inhibiting acetylcholinesterase.
A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled for bypass surgery. Which intervention should the nurse be prepared to implement while this client waits for surgery?
- A. Administration of IV furosemide (Lasix)
- B. Initiation of an external pacemaker
- C. Assistance with endotracheal intubation
- D. Placement of central venous access
Correct Answer: B
Rationale: An 80% blockage of the RCA can lead to bradycardia or heart block. An external pacemaker may be needed to maintain adequate heart rate and cardiac output.
A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:
- A. Pain
- B. Pulses
- C. Hemoglobin and hematocrit levels
- D. Catheterization report
Correct Answer: B
Rationale: Checking pulsesâ€â€especially in the canulated extremityâ€â€assures perfusion to that extremity and is the priority postprocedure.
Two days after a nephrectomy, the client reports abdominal pressure and nausea, which assessment should the nurse implement?
- A. Palpate the abdomen
- B. Measure hourly urine output
- C. Ambulate client in hallway
- D. Auscultate bowel sounds
Correct Answer: D
Rationale: Auscultating bowel sounds helps assess for any bowel obstruction or ileus, which could be contributing to abdominal pressure.