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A nurse is caring for a client who has a new diagnosis of Cushing's syndrome. Which of the following findings should the nurse expect?
- A. Weight gain
- B. Weight loss
- C. Bradycardia
- D. Hypotension
Correct Answer: A
Rationale: Weight gain, especially in the trunk, is a common symptom of Cushing's syndrome due to excess cortisol.
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A nurse is caring for a client who has a new diagnosis of trigeminal neuralgia. Which of the following findings should the nurse expect?
- A. Facial pain
- B. Weight gain
- C. Bradycardia
- D. Hypotension
Correct Answer: A
Rationale: Facial pain, often severe and shock-like, is a hallmark symptom of trigeminal neuralgia affecting the trigeminal nerve.
A nurse in an acute care facility is assisting with the development of an in-service about reducing environmental stressors to improve clients' sleep. Which of the following instructions should the nurse include?
- A. Turn on overhead lights briefly when checking IV lines.
- B. Open curtains between clients in semiprivate rooms.
- C. Wear shoes with rubber soles.
- D. Conduct change-of-shift report near the clients' rooms.
Correct Answer: C
Rationale: Wearing shoes with rubber soles is correct. Rubber-soled shoes reduce noise from footsteps, minimizing disturbances in client rooms and creating a quieter environment that promotes sleep.
A nurse is monitoring a client's lower extremity following the placement of a cast earlier in the day. Which of the following findings should the nurse identify as manifestations of compartment syndrome? (Select all that apply.)
- A. Pale-colored toes
- B. Decreased skin turgor
- C. Pain relieved by analgesia
- D. Diminished capillary refill
- E. Sensation of tingling
Correct Answer: A,D,E
Rationale: Pale-colored toes are a sign of compromised circulation, which is a key manifestation of compartment syndrome. Decreased blood flow to the affected limb can cause pallor, which requires immediate intervention to prevent permanent damage. Diminished capillary refill is correct. Delayed capillary refill (longer than 2 seconds) suggests poor perfusion, which can indicate increased pressure within the compartment. Sensation of tingling is correct. Paresthesia (tingling or numbness) is an early sign of nerve compression due to swelling within the compartment. If untreated, this can progress to permanent nerve and muscle damage.
A nurse is reinforcing teaching with a client who is scheduled for a liver biopsy. Which of the following instructions should the nurse include?
- A. Fast for 8 hours before the procedure.
- B. Expect to stay overnight after the procedure.
- C. Avoid coughing during the procedure.
- D. Take a sedative before the procedure.
Correct Answer: A
Rationale: Fasting for 8 hours before a liver biopsy reduces the risk of complications and ensures a clear procedure field.
A nurse is reinforcing teaching with a client who has a new prescription for a lidocaine patch. Which of the following instructions should the nurse include?
- A. Apply the patch to broken skin.
- B. Remove the patch after 12 hours.
- C. Apply multiple patches at once.
- D. Leave the patch on for 24 hours.
Correct Answer: B
Rationale: Removing the lidocaine patch after 12 hours prevents excessive absorption and reduces the risk of side effects.