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During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client prevent this problem?
- A. Visit her friend early in the day.
- B. Rest for at least an hour before climbing the stairs.
- C. Take a nitroglycerin tablet before climbing the stairs.
- D. Lie down once she reaches the friend's apartment.
Correct Answer: C
Rationale: Taking sublingual nitroglycerin before exertion (e.g., climbing stairs) prevents angina by dilating coronary arteries, increasing myocardial oxygen supply.
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A 17-year-old, sexually active female client is seen in the family planning clinic and requests hormonal contraceptives. Before examination, the nurse should explain the importance of regular Papanicolaou (Pap) smears. This recommendation is based on the current screening guidelines of the American Cancer Society for Pap smears, which state that:
- A. Pap smears are recommended every other year.
- B. If four consecutive annual Pap smears are negative, the client should schedule repeat Pap smears every 3 years.
- C. The initial Pap smear should be done at age 12.
Correct Answer: B
Rationale: American Cancer Society guidelines recommend Pap smears every 3 years after four consecutive normal annual smears for women who are sexually active or over 21. Screening does not start at age 12, and every-other-year screening is not standard.
A nurse is teaching a client with type 1 diabetes mellitus who jogs daily about the preferred sites for insulin absorption. What is the most appropriate site for a client who jogs?
- A. Arms.
- B. Legs.
- C. Abdomen.
- D. Iliac crest.
Correct Answer: C
Rationale: The abdomen is the preferred insulin injection site for active individuals like joggers, as it provides consistent absorption and is less affected by exercise compared to the legs.
The nurse is reviewing the care plan of a client with Multiple Sclerosis. Which of the following nursing diagnoses should receive further validation?
- A. Impaired mobility related to spasticity and fatigue.
- B. Risk for falls related to muscle weakness and sensory loss.
- C. Risk for seizures related to muscle tremors and loss of myelin.
- D. Impaired skin integrity related bowel and bladder incontinence.
Correct Answer: C
Rationale: Seizures are not a common manifestation of MS, as tremors and myelin loss do not directly cause seizures. The other diagnoses are valid, as MS commonly causes mobility issues, fall risks, and skin integrity concerns.
The nurse is caring for a client experiencing acute mountain sickness (AMS). The nurse anticipates a prescription for which medication?
- A. Sodium bicarbonate
- B. Acetazolamide
- C. Tamsulosin
- D. Dutasteride
Correct Answer: B
Rationale: Acetazolamide promotes acclimatization by inducing bicarbonate diuresis, alleviating AMS symptoms. Sodium bicarbonate (A) is used for acidosis, tamsulosin (C) for prostate issues, and dutasteride (D) for benign prostatic hyperplasia, none of which treat AMS.
The nurse is reviewing the postoperative orders (see chart) just written by a physician for a client with insulin-dependent diabetes who has returned to the surgery floor from the recovery. The client has pain of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client's glucose level, the nurse should do which of the following first?
- A. Administer the morphine.
- B. Contact the physician to report the glucose level and rewrite the insulin order.
- C. Administer oxygen per nasal cannula at 2 L/minute.
- D. Take the vital signs.
Correct Answer: B
Rationale: The glucose level must be assessed to determine if insulin is safe to administer, as hypoglycemia could worsen with insulin. Contacting the physician ensures appropriate insulin dosing.