Nokea
A client with terminal cancer is transitioning to hospice care. The nurse should prioritize which of the following in the care plan?
- A. Aggressive pain management.
- B. Curative chemotherapy.
- C. Nutritional supplementation.
- D. Physical therapy.
Correct Answer: A
Rationale: Aggressive pain management is the priority in hospice care to ensure comfort and quality of life for a client with terminal cancer.
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The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit?
- A. I can use heat and cold as often as I want.'
- B. With heat, I should apply it for no longer than 20 minutes at a time.'
- C. Heat-producing liniments can be used with other heat devices.'
- D. Ten to 15 minutes per application is the maximum time for cold applications.'
Correct Answer: A
Rationale: Frequent or prolonged use of heat and cold without guidance can cause tissue damage. The other statements reflect appropriate understanding of time limits and safe use.
What should the nurse teach a client about stoma care?
- A. Clean with hydrogen peroxide.
- B. Measure stoma size weekly.
- C. Apply adhesive remover.
- D. Change pouch every day.
Correct Answer: B
Rationale: Measuring stoma size weekly ensures proper appliance fit as swelling subsides.
The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?
- A. Eggs.
- B. Lettuce.
- C. Citrus fruits.
- D. Cheese.
Correct Answer: A
Rationale: Microcytic hypochromic anemia is often caused by iron deficiency. Eggs are a good source of dietary iron, particularly heme iron, which is well-absorbed by the body. Lettuce and citrus fruits do not provide significant iron, though citrus fruits can enhance iron absorption when consumed with iron-rich foods. Cheese is not a significant source of iron. Therefore, eggs should be included in the diet.
Which of the following will the nurse observe in the ictal phase of a generalized tonic-clonic seizure?
- A. Linking in one extremity that spreads gradually to adjacent areas.
- B. Vacant staring and abruptly ceasing all activity.
- C. Facial grimaces, patting motions, and lip smacking.
- D. Loss of consciousness, body stiffening, and violent muscle contractions.
Correct Answer: D
Rationale: The ictal phase of a generalized tonic-clonic seizure is characterized by loss of consciousness, body stiffening (tonic phase), and violent muscle contractions (clonic phase). The other options describe focal or absence seizures.
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