Nokea
A client with colon cancer is having a barium enema. The nurse should instruct the client to take which of the following after the procedure is completed?
- A. Laxative.
- B. Anticholinergic.
- C. Antacid.
- D. Demulcent.
Correct Answer: A
Rationale: After a barium enema, a laxative is ordinarily prescribed. This is done to promote elimination of the barium. Retained barium predisposes the client to constipation and fecal impaction. Anticholinergic drugs decrease gastrointestinal motility. Antacids decrease gastric acid secretion. Demulcents soothe mucous membranes of the gastrointestinal tract and are used to treat diarrhea. CN: Reduction of risk potential; CL: Synthesize
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The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first?
- A. Assess respiratory status.
- B. Draw blood for laboratory studies.
- C. Insert a Foley catheter.
- D. Weigh the client.
Correct Answer: A
Rationale: Edema and left ventricular enlargement suggest heart failure, which can cause pulmonary edema. Assessing respiratory status first detects signs of respiratory distress.
A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related adverse effects?
- A. Constipation.
- B. Hyperkalemia.
- C. Irregular pulse.
- D. Dysuria.
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, so hyperkalemia (B) is a key adverse effect. Constipation (A), irregular pulse (C), and dysuria (D) are not typical.
Which statement by a client with a new ileal conduit indicates a need for further teaching?
- A. I will empty the pouch when it is one-third full.
- B. I can use vinegar to clean my appliance.
- C. I should drink 2,000 mL of fluid daily.
- D. I will wear tight clothing to hide the pouch.
Correct Answer: D
Rationale: Tight clothing can irritate the stoma and impair appliance function, indicating a misunderstanding of proper care.
A client with diabetes mellitus asks the nurse to recommend something to remove corns from his toes. The nurse should advise the client to:
- A. Apply a high-quality corn plaster to the area.
- B. Consult a physician or podiatrist about removing the corns.
- C. Apply iodine to the corns before peeling them off.
- D. Soak the feet in borax solution to peel off the corns.
Correct Answer: B
Rationale: Corns should be professionally removed by a physician or podiatrist to avoid injury or infection, especially in diabetic clients with poor healing.
The nurse is caring for a client with a femoral fracture in traction. Which observation indicates a potential complication?
- A. Client reports mild discomfort.
- B. Traction ropes are aligned with the pulley.
- C. Foot is pale and cool to touch.
- D. Pin sites are clean and dry.
Correct Answer: C
Rationale: A pale, cool foot suggests impaired circulation, a serious complication requiring immediate attention.