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A client with bladder cancer reports fatigue and weight loss. The nurse should assess for:
- A. Metastasis.
- B. Dehydration.
- C. Infection.
- D. Anemia.
Correct Answer: A
Rationale: Fatigue and weight loss in bladder cancer may indicate metastasis, as the disease progresses.
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The nurse has just admitted a 35-year-old female client who has a serum vitamin B12 concentration of 800 pg/mL. Which of the following laboratory findings should cue the nurse to focus the client history assessment on specific drug or alcohol use?
- A. Total bilirubin, 0.3 mg/dL.
- B. Serum creatinine, 0.5 mg/dL.
- C. Hemoglobin, 16 g/dL.
- D. Folate, 1.5 ng/mL.
Correct Answer: D
Rationale: A serum vitamin B12 level of 800 pg/mL is within the normal range (200–900 pg/mL), but a folate level of 1.5 ng/mL is low (normal: 2.7–17 ng/mL). Low folate levels can be associated with chronic alcohol use, as alcohol impairs folate absorption and metabolism. The nurse should assess the client's history for alcohol use, as this may contribute to the folate deficiency. The other lab values (bilirubin, creatinine, hemoglobin) are normal and do not suggest drug or alcohol use.
The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods?
- A. Proper body alignment.
- B. Elevating the part.
- C. Prone lying positions.
- D. Positions of flexion.
Correct Answer: D
Rationale: Positions of flexion can exacerbate joint stiffness and deformity in rheumatoid arthritis. Proper alignment, elevation, and prone positions (if comfortable) support joint health.
A client with a hip fracture is using a walker. Which observation indicates incorrect use of the walker?
- A. The client leans forward over the walker.
- B. The client advances the walker before stepping.
- C. The client uses the walker on both sides.
- D. The client keeps elbows slightly bent.
Correct Answer: A
Rationale: Leaning forward over the walker compromises balance and increases fall risk.
When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the client to expect to:
- A. Develop respiratory infections easily.
- B. Maintain current status.
- C. Require less supplemental oxygen.
- D. Show permanent improvement.
Correct Answer: A
Rationale: COPD clients are prone to respiratory infections due to impaired lung defenses. Maintaining status is possible but not an expectation. Oxygen needs may increase, and COPD is progressive, not permanently improved.
A client uses a metered-dose inhaler (MDI) to aid in management of his asthma. Which action by the client indicates to the nurse that he needs further instruction regarding its use? Select all that apply.
- A. Activation of the MDI is not coordinated with inspiration.
- B. The client inspires rapidly when using the MDI.
- C. The client holds his breath for 3 seconds after inhaling with the MDI.
- D. The client shakes the MDI after use.
- E. The client performs puffs in rapid succession.
Correct Answer: A,B,C,E
Rationale: Incorrect MDI use includes not coordinating activation with inspiration (A), rapid inspiration (B), holding breath for only 3 seconds (C; should be 10 seconds), and rapid successive puffs (E; wait 1 minute between puffs). Shaking after use (D) is incorrect but less critical.