Nokea
A client with vasospastic disorder (Raynaud's phenomenon) is scheduled for sympathectomy. This surgery is performed:
- A. In the early stages of the disease to prevent further circulatory disturbances
- B. When the disease is controlled by medication
- C. When the client is unable to control stress-related vasospasm
- D. When all other treatment alternatives have failed
Correct Answer: D
Rationale: Sympathectomy, which severs sympathetic nerves to reduce vasospasm, is a last-resort treatment for Raynaud's when all other options (medications, lifestyle changes) fail. It is not performed early, when controlled, or solely for stress-related vasospasm.
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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.
Which of the following clients is at greatest risk for Buerger's disease?
- A. A 29-year-old male with a 14-year history of cigarette smoking
- B. A 38-year-old female who is taking birth control pills
- C. A 54-year-old female with adult onset diabetes
- D. A 65-year-old male with atherosclerosis
Correct Answer: A
Rationale: Buerger's disease (thromboangiitis obliterans) is strongly associated with heavy tobacco use, particularly in young males. A 29-year-old male with a 14-year smoking history is at greatest risk. Birth control pills, diabetes, and atherosclerosis are not primary risk factors for Buerger's disease.
When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply.
- A. Becoming increasingly short of breath at rest.
- B. Weight gain of 2 lb or more in 1 day.
- C. High intake of sodium for breakfast.
- D. Having to sleep sitting up in a reclining chair.
- E. Weight loss of 2 lb in 1 day.
Correct Answer: A,B,D
Rationale: Shortness of breath at rest (A), weight gain of 2 lb or more in 1 day (B), and sleeping sitting up (D) indicate worsening heart failure, requiring physician notification.
A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following?
- A. Tachycardia.
- B. Weight gain.
- C. Diarrhea.
- D. Nausea.
Correct Answer: B
Rationale: Hypothyroidism causes a slowed metabolism, leading to weight gain. Tachycardia, diarrhea, and nausea are more associated with hyperthyroidism.
The nurse is planning a home visit for a client with hepatitis. In order to prevent transmission the nurse should focus teaching on:
- A. Proper food handling.
- B. Insulin syringe disposal.
- C. Alpha-interferon.
- D. Use of condoms.
Correct Answer: D
Rationale: Hepatitis B and C are transmitted via body fluids, so condom use (D) prevents sexual transmission. Food handling (A) is more relevant for hepatitis A. Syringe disposal (B) applies to needle-sharing risks, and alpha-interferon (C) is treatment, not prevention.