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A client with a history of asthma is admitted with severe shortness of breath and cyanosis. Which finding would indicate that the client is experiencing status asthmaticus?
- A. Increased vocal fremitus
- B. Silent chest on auscultation
- C. Stridor during inspiration
- D. Rhonchi in bilateral lung fields
Correct Answer: B
Rationale: Silent chest on auscultation indicates severe airway obstruction with minimal air movement, a hallmark of status asthmaticus, requiring immediate intervention.
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The nurse in the outpatient clinic is caring for assigned clients with type 1 diabetes mellitus. Which client should the nurse recognize as having the highest risk of developing hypoglycemia?
- A. 29-year-old client with new-onset influenza
- B. 40-year-old client who is a cyclist and is training for an upcoming race
- C. 65-year-old client with cellulitis of the right leg
- D. 72-year-old client with emphysema who is receiving prednisone
Correct Answer: D
Rationale: Prednisone increases blood glucose, but abrupt cessation or dose changes can cause hypoglycemia in type 1 diabetes due to insulin sensitivity. Influenza, exercise, and cellulitis pose risks, but prednisone’s metabolic impact is greatest.
The nurse is screening clients for those at risk for developing endometrial cancer. Which of the following clients is at highest risk for developing endometrial cancer?
- A. 42-year-old client who has been taking a progestin-containing oral contraceptive for 10 years
- B. 45-year-old client who has a history of one ectopic pregnancy and two births
- C. 51-year-old client who has polycystic ovary syndrome and is obese
- D. 54-year-old client who has a history of hysterectomy for uterine fibroids
Correct Answer: C
Rationale: Obesity and polycystic ovary syndrome (PCOS) increase endometrial cancer risk due to excess estrogen from adipose tissue and anovulation. Ectopic pregnancy and births are not significant risk factors.
The nurse is reinforcing teaching with a client who has a prescription for sertraline for the treatment of depression. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I can discontinue the medication as soon as I start feeling better
- B. I should avoid eating aged cheeses, cured meats, or pickled foods
- C. I should expect to feel better within 2 to 3 days after starting this medication
- D. I will report any thoughts of self-harm to my health care provider
Correct Answer: D
Rationale: Reporting self-harm thoughts is critical, as sertraline may increase suicide risk initially. Discontinuing abruptly risks relapse, food restrictions apply to MAOIs, and benefits take weeks, not days.
The nurse is reviewing new medication prescriptions for a client who has a suspected brain tumor. The client is scheduled for a CT scan of the head with IV iodinated contrast in 24 hours. The nurse should clarify the prescription for
- A. gabapentin
- B. amlodipine
- C. metformin
- D. phenytoin
Correct Answer: C
Rationale: Metformin should be held before and after iodinated contrast due to the risk of lactic acidosis if contrast-induced kidney injury occurs. Gabapentin, amlodipine, and phenytoin are safe with contrast.
The nurse is reinforcing teaching with a client who has a new prescription for Rh immunoglobulin. The client has an Rh-negative blood type and gave birth 24 hours ago to a newborn who has an Rh-positive blood type. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I need the medication now because the dose I received during pregnancy was ineffective
- B. I can receive the medication at my follow-up appointment in 6 weeks
- C. I need to have a blood specimen obtained in 3 months to verify that the medication was effective
- D. I will receive the medication to prevent my body from forming antibodies
Correct Answer: D
Rationale: Rh immunoglobulin prevents antibody formation against Rh-positive fetal blood, given within 72 hours postpartum. The prenatal dose is separate, 6 weeks is too late, and 3-month testing is not standard.