Nokea
A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses and this result means?
- A. fibrin degradation fragment; positive for a blood clot
- B. platelet degradation protein; negative for a blood clot
- C. clotting factors; positive for a blood clot
- D. fibrin degradation fragment; negative for a blood clot
Correct Answer: D
Rationale: A d-dimer test assess fibrin degradation fragment. This test doesn't tell us where the clot may be (so it not specific) so it will need to be further investigated by the MD and a positive result doesn't necessarily mean the patient has a clot because some disease processes can cause a false positive. Also, a normal d-dimer is <500 ng/mL (FEU). However, it depends on how the lab reports the assay cut-off value for the d-dimer. Some labs have a cutoff <250 ng/mL (D-DU). However, <500 ng/mL (FEU) is equivalent to <250 ng/mL (D-DU).
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The 56-year-old client diagnosed with tuberculosis (Tb) is being discharged. Which statement made by the client indicates an understanding of the discharge instructions?
- A. I will take my medication for the full three (3) weeks prescribed.
- B. I must stay on the medication for months if I am to get well.
- C. I can be around my friends because I have started taking antibiotics.
- D. I should get a Tb skin test every three (3) months to determine if I am well.
Correct Answer: B
Rationale: TB treatment requires months of antibiotics (B) for cure. Three weeks (A) is too short, antibiotics don’t eliminate transmission risk immediately (C), and skin tests (D) monitor exposure, not cure.
The client admitted for recurrent aspiration pneumonia is at risk for bronchiectasis. Which intervention should the nurse anticipate the health-care provider to order?
- A. Administer intravenous antibiotics for seven (7) days.
- B. Insert a subclavian line and initiate total parenteral nutrition.
- C. Provide a low-calorie and low-sodium restricted diet.
- D. Encourage the client to turn, cough, and deep breathe frequently.
Correct Answer: D
Rationale: Recurrent aspiration pneumonia predisposes to bronchiectasis due to chronic airway damage. Turning, coughing, and deep breathing (D) prevent secretion stasis and further infections. Antibiotics (A) treat active infection, not prevention. TPN (B) is for malnutrition, not directly related. Dietary restrictions (C) are irrelevant.
The HCP has recommended a total laryngectomy for a male client diagnosed with cancer of the larynx but the client refuses. Which intervention by the nurse illustrates the ethical principle of nonmalfeasance?
- A. The nurse listens to the client explain why he is refusing surgery.
- B. The nurse and significant other insist that the client have the surgery.
- C. The nurse refers the client to a counselor for help with the decision.
- D. The nurse asks a cancer survivor to come and discuss the surgery with the client.
Correct Answer: A
Rationale: Listening to the client’s reasons (A) respects autonomy and avoids harm (nonmalfeasance). Insisting (B), counseling (C), and survivor talks (D) may pressure or influence unduly.
The client is diagnosed with cancer of the larynx and is to have radiation therapy to the area. Which prophylactic procedure will the nurse prepare the client for?
- A. Removal of the client's teeth and fitting for dentures.
- B. Take antiemetic medications every four (4) hours.
- C. Wear sunscreen on the area at all times.
- D. Placement of a nasogastric feeding tube.
Correct Answer: A
Rationale: Dental extraction (A) prevents radiation-induced tooth decay. Antiemetics (B), sunscreen (C), and NG tubes (D) are not prophylactic for laryngeal radiation.
A client who had a laryngectomy is nearly ready for discharge. Which instruction is most appropriate for the nurse to give?
- A. Always be sure you have a buddy with you when you go swimming or boating.'
- B. You may take a tub bath, but you should not take a shower.'
- C. Be sure to have only liquids for another three weeks.'
- D. Never cover your stoma with anything.'
Correct Answer: A
Rationale: A buddy is essential during swimming or boating to ensure safety, as water entering the stoma can cause aspiration.