Nokea
A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer?
- A. A 25-year-old female with a history of sexually transmitted diseases
- B. A 42-year-old male who has worked in a lumber yard for 10 years
- C. A 55-year-old female who has had numerous episodes of bacterial cystitis
- D. An 86-year-old male with a 50-pack-year cigarette smoking history
Correct Answer: D
Rationale: The correct answer is D. The greatest risk factor for bladder cancer is a long history of tobacco use, which is reflected in an 86-year-old male with a 50-pack-year cigarette smoking history. Smoking is a well-established risk factor for developing bladder cancer. Choices A, B, and C are not directly linked to an increased risk of bladder cancer. While sexually transmitted diseases, certain occupational exposures, and recurrent urinary tract infections may pose other health risks, they are not specifically associated with an elevated risk of bladder cancer.
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After checking the client's gag reflex following an esophagogastroduodenoscopy (EGD), which action should the nurse take?
- A. Taking the client's vital signs
- B. Giving the client a drink of water
- C. Monitoring the client for a sore throat
- D. Being alert to complaints of heartburn
Correct Answer: A
Rationale: After an esophagogastroduodenoscopy (EGD), the nurse's priority is to assess the client's airway by checking the gag reflex. Once this assessment is done, the next step is to take the client's vital signs to monitor for any signs of complications such as bleeding or changes in respiratory status. Giving the client water immediately after the procedure may not be appropriate, as the client may still have a compromised gag reflex and is at risk for aspiration. Monitoring for a sore throat is important but not the immediate priority post-procedure. Being alert to complaints of heartburn is relevant for assessing the client's symptoms but is not the priority immediately after checking the gag reflex.
The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?
- A. Contact the provider to request an order for serum electrolytes.
- B. Encourage the patient to consume less fluids.
- C. Report symptoms of hyperkalemia to the provider.
- D. Request an order to increase the patient's potassium dose.
Correct Answer: A
Rationale: Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes to assess the patient's potassium levels. Encouraging the patient to consume less fluids would not address the underlying issue of potential hyperkalemia. Reporting symptoms of hyperkalemia to the provider is not as proactive as directly requesting serum electrolytes. Increasing the patient's potassium dose would worsen hyperkalemia, which is already suspected based on the symptoms presented.
A client has made an appointment for her annual Papanicolaou test (a.k.a. Pap smear). The nurse who schedules the appointment should tell the client that:
- A. The test cannot be performed while the client is menstruating
- B. Vaginal douching is required at least 24 hours before the test
- C. Spicy foods should not be eaten on the day of the test
- D. The test has absolutely no discomfort associated with it
Correct Answer: A
Rationale: The correct answer is A. A Pap smear cannot be performed with accurate results during menstruation. Menstrual blood may interfere with the test results. Choice B is incorrect as vaginal douching should be avoided for at least 24 hours before the test to prevent altering the cervical cells. Choice C is incorrect as there is no restriction on spicy foods before a Pap smear. Choice D is incorrect as some women may experience mild discomfort during the test, although it is generally well-tolerated.
The healthcare provider is caring for a 7-year-old patient who will receive oral antibiotics. Which antibiotic order will the healthcare provider question for this patient?
- A. Azithromycin (Zithromax)
- B. Clarithromycin (Biaxin)
- C. Clindamycin (Cleocin)
- D. Tetracycline (Sumycin)
Correct Answer: D
Rationale: The correct answer is D, Tetracycline (Sumycin). Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth. Azithromycin, Clarithromycin, and Clindamycin are antibiotics that are generally safe for use in children and do not have the same tooth discoloration side effect as Tetracycline. Therefore, these antibiotics would be more appropriate choices for a 7-year-old patient.
A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?
- A. Document findings and continue to monitor the client.
- B. Contact the provider and recommend a 24-hour urine test.
- C. Review the client's recent dietary selections.
- D. Perform a capillary artery glucose assessment.
Correct Answer: D
Rationale: Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the client's dietary selections will not assist the nurse to make a clinical decision related to this abnormality.