Nokea
A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The nurse's discharge teaching should include:
- A. Telling the client's wife not to touch the tablets
- B. Explaining that the medication should be taken with meals
- C. Telling the client that symptoms will improve in 1-2 weeks
- D. Instructing the client to take the medication at bedtime, to prevent nocturia
Correct Answer: A
Rationale: Finasteride tablets should not be handled by pregnant women due to the risk of fetal harm. This is a critical teaching point for safety.
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An ICU nurse monitors a client recovering from a head injury. The client's intracranial pressure (ICP) has been between 15 and 19 mmHg throughout the shift. However, after the nurse suctions the client's endotracheal tube, the ICP jumps to 28 mmHg. It decreases a few minutes later to 20 mmHg. The best intervention by the nurse is to
- A. increase the rate of the sedative IV drip.
- B. chart the findings and continue to monitor the client.
- C. reposition the client.
- D. contact the physician.
Correct Answer: D
Rationale: A sudden ICP spike to 28 mmHg post-suctioning suggests a significant issue (e.g., impaired cerebral perfusion). The physician should be contacted for evaluation.
A client is admitted with a blood alcohol level of 180 mg/dL. The nurse recognizes that the alcohol in the client's system should be fully metabolized within:
- A. 3 hours
- B. 5 hours
- C. 7 hours
- D. 9 hours
Correct Answer: D
Rationale: A blood alcohol level of 180 mg/dL (0.18%) typically takes about 9 hours to metabolize, assuming a metabolism rate of 0.02% per hour.
The nurse has just received a report from the previous shift. Which of the following clients should the nurse visit first?
- A. A 50-year-old COPD client with a PCO2 of 50
- B. A 24-year-old admitted after an MVA complaining of shortness of breath
- C. A client with cancer requesting pain medication
- D. A 1-day post-operative cholecystectomy with a temperature of 100°F
Correct Answer: B
Rationale: Shortness of breath post-MVA suggests potential trauma (e.g., pneumothorax), requiring immediate assessment. The other clients' conditions are less acute.
The nurse is aware that African-Americans are at higher risk than Caucasians for which of the following conditions? Select all that apply.
- A. Hypertension.
- B. Diabetes mellitus.
- C. Asthma.
- D. Skin cancer.
- E. Osteoporosis.
Correct Answer: A,B
Rationale: African-Americans have a higher risk for hypertension (A) and diabetes mellitus (B) compared to Caucasians due to genetic and socioeconomic factors. Asthma (C) risk is similar across groups, while skin cancer (D) and osteoporosis (E) are less prevalent in African-Americans.
Lochia serosa usually is evident on days 4 to 10 postpartum. When teaching the client about postpartum care, how should the nurse describe lochia serosa?
- A. Dark red discharge with small clots
- B. Yellowish discharge
- C. Pinkish to brownish discharge
- D. Clear watery discharge
Correct Answer: C
Rationale: Lochia serosa, days 4-10 postpartum, is pinkish to brownish (C) due to decreased blood and increased serous fluid. Dark red (A) is lochia rubra, yellowish (B) or clear (D) are not typical.