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Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is distressed about hair loss. The nurse should do which of the following?
- A. Have the client wash and massage the scalp daily to stimulate hair growth.
- B. Explain that hair loss is temporary and will quickly grow back to its original appearance.
- C. Provide resources for a wig selection before hair loss begins.
- D. Recommend that the client limit social contacts until hair regrows.
Correct Answer: C
Rationale: Providing resources for wig selection before hair loss begins helps the client prepare for and cope with chemotherapy-induced alopecia, maintaining her self-esteem.
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A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. The nurse should first:
- A. Ask what medications the client is taking.
- B. Complete a history and health assessment.
- C. Identify the time of onset of the stroke.
- D. Determine if the client is scheduled for any surgical procedures.
Correct Answer: C
Rationale: The time of stroke onset is critical for t-PA administration, as it must be given within a specific window (typically 3-4.5 hours) to be effective and safe. Other assessments follow this priority.
The nurse is planning care for a client who had surgery for abdominal aortic aneurysm repair 2 days ago. The pain medication and the use of relaxation and imagery techniques are not relieving the client's pain and the client refuses to get out of bed to ambulate as ordered. The nurse contacts the physician, explains the situation, and provides information about drug dose, frequency of administration, the client's vital signs, and the client's score on the pain scale. The physician tells the nurse that the current order for pain medication is sufficient and the client will be fine in a few days. The nurse should next:
- A. Explain to the physician that the current pain medication and other strategies are not helping the client and it is making it difficult for the client to ambulate as ordered
- B. Ask the hospitalist to write an order for a stronger pain medication
- C. Wait until the next shift and ask the nurse on that shift to contact the physician
- D. Report the incident to the team leader
Correct Answer: A
Rationale: The nurse should advocate for the client by reiterating to the physician that the current pain management is ineffective, preventing ambulation, which is critical for recovery post-AAA repair. This aligns with ethical and professional standards. Asking another provider, waiting, or reporting to the team leader delays care.
Which of the following hospitalized clients is at risk to develop parotitis?
- A. A 50-year-old client with nausea and vomiting who is on nothing-by-mouth status.
- B. A 75-year-old client with diabetes who has ill-fitting dentures.
- C. An 80-year-old client who has poor oral hygiene and is dehydrated.
- D. A 65-year-old client with lung cancer who has a feeding tube in place.
Correct Answer: C
Rationale: Dehydration and poor oral hygiene in the 80-year-old client increase the risk of parotitis due to reduced saliva production and bacterial overgrowth.
While the nurse is providing preoperative teaching, the client says, 'I hate the idea of being an invalid after they cut off my leg.' The nurse's most therapeutic response should be:
- A. You'll still have one good leg to use.'
- B. Tell me more about how you're feeling.'
- C. Let's finish the preoperative teaching.'
- D. You're fortunate to have a wife who can take care of you.'
Correct Answer: B
Rationale: The therapeutic response, 'Tell me more about how you're feeling,' encourages the client to express fears and concerns, facilitating emotional support and coping. The other responses dismiss the client's feelings, prioritize teaching, or make assumptions, which are less therapeutic.
A client was admitted to the hospital with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance?
- A. What daily activities were you able to do 6 months ago compared with the present?'
- B. How long have you had this problem?'
- C. Have you been able to keep up with all your usual activities?'
- D. Are you more tired now than you used to be?'
Correct Answer: A
Rationale: To assess activity intolerance, the nurse should compare the client's current activity level with their previous capabilities. Asking about specific activities performed 6 months ago versus now provides concrete data on the extent of intolerance. The other questions are less specific and do not directly quantify changes in activity capacity.