Nokea
A nurse evaluates a client's PSA lab results. An increase in PSA indicates what condition?
- A. Benign prostatic hyperplasia
- B. Prostatic cancer
- C. Urinary tract infection
- D. Kidney stones
Correct Answer: B
Rationale: The correct answer is B: Prostatic cancer. PSA levels are commonly used as a marker for prostate cancer. Elevated PSA levels indicate an increased likelihood of prostate cancer. Benign prostatic hyperplasia (choice A) is a non-cancerous condition that can also cause elevated PSA levels but is not indicative of cancer. Urinary tract infection (choice C) and kidney stones (choice D) do not directly affect PSA levels. The other choices (E, F, G) are not provided, but the key is to understand that an increase in PSA specifically points towards the possibility of prostatic cancer.
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A nurse in an emergency room is caring for a client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?
- A. Inspect the mouth for signs of inhalation injuries
- B. Administer pain medication
- C. Place the client on oxygen therapy
- D. Start an intravenous line
Correct Answer: A
Rationale: The correct answer is A: Inspect the mouth for signs of inhalation injuries. This is the priority action because inhalation injuries can be life-threatening and must be assessed immediately in burn patients. Burns to the face and chest increase the risk of inhalation injuries due to the proximity to the airway. Administering pain medication, placing the client on oxygen therapy, and starting an IV line are important interventions but inspecting the mouth for signs of inhalation injuries takes precedence in this situation to ensure the client's airway is not compromised.
A nurse is completing discharge teaching with a client following arthroscopic knee surgery. Which of the following instructions should the nurse include in the teaching?
- A. Keep the knee elevated above the heart at all times.
- B. Avoid physical therapy for 2 weeks.
- C. Apply ice to the affected area.
- D. Limit fluid intake to reduce swelling.
Correct Answer: C
Rationale: The correct answer is C: Apply ice to the affected area. Ice application helps reduce swelling and pain post-surgery. Keeping the knee elevated above the heart (A) is important, but not at all times as it can lead to other issues like blood pooling. Avoiding physical therapy for 2 weeks (B) is incorrect as early mobilization is crucial for recovery. Limiting fluid intake (D) is not recommended as hydration is essential for healing.
A nurse is caring for a client who has myelosuppression after receiving chemotherapy. The nurse should monitor the client for which of the following adverse effects?
- A. Bleeding from the gums
- B. Chest pain
- C. Fatigue
- D. Severe headache
Correct Answer: A
Rationale: The correct answer is A: Bleeding from the gums. Myelosuppression leads to decreased production of blood cells, including platelets, which are essential for clotting. Bleeding from the gums is a common sign of thrombocytopenia, a condition where there are low platelet levels. Chest pain, fatigue, and severe headache are not directly associated with myelosuppression. Monitoring for bleeding tendencies is crucial in clients with myelosuppression to prevent complications like hemorrhage.
A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?
- A. Cold and numbness distal to the fistula site
- B. Pallor and numbness distal to the fistula site
- C. Redness and warmth at the fistula site
- D. Pain in the fistula site
Correct Answer: B
Rationale: The correct answer is B: Pallor and numbness distal to the fistula site. This is indicative of venous insufficiency in a client with an arteriovenous fistula. Venous insufficiency occurs when there is inadequate venous return to the heart, leading to decreased blood flow and oxygen delivery to the tissues. Pallor and numbness are signs of decreased blood flow, which can occur when the fistula is not functioning properly. Cold and numbness (choice A) may indicate arterial insufficiency, not venous. Redness and warmth (choice C) are signs of inflammation, not venous insufficiency. Pain in the fistula site (choice D) may be due to other reasons like infection or nerve compression, not necessarily venous insufficiency.
A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?
- A. Hyperglycemia
- B. Tachycardia
- C. Hypertension
- D. Bradycardia
Correct Answer: D
Rationale: The correct answer is D: Bradycardia. Atenolol is a beta-blocker that slows down the heart rate, leading to bradycardia as an adverse effect. This occurs because atenolol blocks the action of adrenaline on the heart, causing the heart to beat slower. Hyperglycemia (A) is not a common adverse effect of atenolol; in fact, it may even lower blood sugar levels slightly. Tachycardia (B) and hypertension (C) are the opposite effects of atenolol, as it is used to treat high blood pressure and reduce heart rate. Therefore, these would not be expected adverse effects.