Nokea
A terminally ill male client and his family request hospice care after discharge. What aspect of care should the nurse indicate is the focus of hospice?
- A. Enhance symptom management to improve end-of-life quality
- B. Facilitate assisted suicide with the client's consent
- C. Offer ways to postpone the death experience at home
- D. Provide training for family members to care for the client
Correct Answer: A
Rationale: The correct answer is A. Hospice care focuses on enhancing symptom management to improve the end-of-life quality for terminally ill patients and their families. Hospice aims to provide comfort, dignity, and support during the end-of-life journey. Choice B is incorrect as hospice care does not involve assisted suicide but focuses on providing palliative care. Choice C is incorrect as hospice care does not aim to postpone the death experience but rather to provide support and comfort during this time. Choice D is incorrect as while hospice care may involve educating family members on caring for the client, the primary focus is on symptom management and quality of life.
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A client with a history of seizures is being discharged home. Which instruction is most important for the nurse to provide?
- A. Take your medication as prescribed.
- B. Avoid driving until your condition is stable.
- C. Keep a seizure diary.
- D. Avoid alcohol consumption.
Correct Answer: A
Rationale: The most important instruction for a client with a history of seizures being discharged home is to take their medication as prescribed. Consistent and timely intake of anti-seizure medication is vital in managing seizures and preventing episodes. While instructions like avoiding driving until the condition is stable, keeping a seizure diary, and avoiding alcohol consumption are important, none are as critical as ensuring proper medication adherence to control seizures effectively. Failure to take prescribed medications can lead to breakthrough seizures, compromising the patient's safety and seizure control.
What is the function of the cervix in reproduction?
- A. Accepts and interprets signals of sexual stimuli
- B. Secretes mucus to facilitate sperm transport
- C. Serves as the site for union of ovum and sperm
- D. Receives the penis during intercourse
Correct Answer: B
Rationale: The cervix functions in reproduction by secreting mucus that facilitates the transport of sperm to the uterus. Choice A is incorrect because the cervix does not interpret signals of sexual stimuli. Choice C is incorrect as the site for the union of ovum and sperm is the fallopian tube. Choice D is incorrect as the cervix is not involved in receiving the penis during intercourse.
The nurse is planning to ambulate a client who has been on bed rest for 24 hours following a Colon Resection. To ambulate this client safely, which intervention should the nurse implement first?
- A. Place non-skid shoes on the client
- B. Show the client how to use the call light
- C. Use a gait belt to support the client
- D. Assist the client to a bedside sitting position
Correct Answer: D
Rationale: To ambulate a client safely after a period of bed rest, the nurse should first assist the client to a bedside sitting position. This initial step ensures the client is stable before attempting to stand and walk, reducing the risk of falls and allowing for a gradual adjustment to activity post-bed rest. Placing non-skid shoes, showing how to use the call light, or using a gait belt are important but should come after ensuring the client is safely seated and stable.
The nurse is assessing a client with an IV infusion of normal saline. The client reports pain and swelling at the IV site. What should the nurse do first?
- A. Slow the rate of infusion
- B. Apply a warm compress to the site
- C. Elevate the affected arm
- D. Discontinue the IV infusion
Correct Answer: D
Rationale: The correct answer is to discontinue the IV infusion. Pain and swelling at the IV site may indicate infiltration or phlebitis, which requires immediate discontinuation of the infusion to prevent further complications. Continuing the infusion can lead to tissue damage or infection. Slowing the rate of infusion, applying a warm compress, or elevating the affected arm would not address the underlying issue of infiltration or phlebitis and could potentially worsen the condition by allowing more fluid to infiltrate the tissues.
A client with a history of hypertension is prescribed hydrochlorothiazide (HCTZ). Which adverse effect should the nurse monitor for?
- A. Hyperkalemia
- B. Hyponatremia
- C. Bradycardia
- D. Hyperglycemia
Correct Answer: B
Rationale: The correct answer is 'B. Hyponatremia.' Hydrochlorothiazide can lead to electrolyte imbalances, such as hyponatremia, due to its diuretic effect. This potential adverse effect should be closely monitored in patients taking HCTZ. Choice A, hyperkalemia, is less likely to occur with HCTZ as it tends to cause hypokalemia. Choice C, bradycardia, is not a common adverse effect of HCTZ. Choice D, hyperglycemia, is also less commonly associated with HCTZ use compared to hyponatremia.