Nokea
For a patient on the chemotherapeutic drug vincristine (Oncovin), which of the following side effects should be reported to the physician?
- A. Fatigue.
- B. Nausea and vomiting.
- C. Paresthesia.
- D. Anorexia.
Correct Answer: C
Rationale: Paresthesia is a serious neurotoxic side effect of vincristine and requires immediate medical attention.
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A 72-year-old male client had the Foley catheter removed today, which was inserted during the transurethral resection of the prostate (TURP). The client is concerned about the urinary incontinence he has experienced since removal of the Foley catheter. The nurse should explain to the client that:
- A. he should not be concerned, because it will be quickly resolved.
- B. urinary incontinence is usually temporary.
- C. he should notify the nurse when this happens.
- D. this is related to the bladder spasms and will soon stop.
Correct Answer: B
Rationale: Urinary incontinence is usually temporary, but the problem may take some time to resolve, especially in an older male. Bladder spasms are not the cause of the client's incontinence.
The most common, preventable complication of abdominal surgery is
- A. atelectasis.
- B. fluid and electrolyte imbalance.
- C. thrombophlebitis.
- D. urinary retention.
Correct Answer: D
Rationale: Urinary retention is a common issue post-abdominal surgery due to anesthesia effects and immobility.
A healthcare provider is assessing a client who had a myocardial infarction. Upon auscultating heart sounds, the provider hears the following sound. What action by the provider is most appropriate?
- A. Assess the client's lung sounds.
- B. Call the Rapid Response Team.
- C. Have the client sit upright.
- D. Listen to the client's lung sounds.
Correct Answer: A
Rationale: The correct answer is A: Assess the client's lung sounds. This is important because after a myocardial infarction, there is a risk of pulmonary edema, which can present as crackles or wheezes in the lungs. By assessing the lung sounds, the healthcare provider can identify any signs of respiratory distress and promptly intervene if necessary.
Choice B is incorrect because calling the Rapid Response Team is not warranted based solely on abnormal heart sounds. Choice C is incorrect as having the client sit upright is not directly related to addressing abnormal heart sounds. Choice D is also incorrect as it focuses solely on assessing lung sounds without considering the potential implications of the abnormal heart sounds.
A client with newly diagnosed osteoporosis is being taught about lifestyle modifications. Which instruction should be included?
- A. Increase intake of caffeinated beverages.
- B. Engage in weight-bearing exercises regularly.
- C. Avoid exposure to sunlight.
- D. Take calcium supplements with iron.
Correct Answer: B
Rationale: Step 1: Weight-bearing exercises help improve bone density and strength, crucial in managing osteoporosis.
Step 2: Regular engagement in weight-bearing exercises can reduce the risk of fractures in individuals with osteoporosis.
Step 3: Increasing intake of caffeinated beverages can contribute to bone loss.
Step 4: Avoiding exposure to sunlight can decrease vitamin D levels necessary for calcium absorption.
Step 5: Taking calcium supplements with iron may interfere with calcium absorption.
Summary: Choice B is correct as weight-bearing exercises are essential for managing osteoporosis. Choices A, C, and D are incorrect because they can have negative impacts on bone health.
A nurse criticizes the attending physician and suggests that a different physician should care for the patient. What is your best response?
- A. Call the nurse away from the patient and remind him that the patient can still hear even if unconscious.
- B. Report the nurse to the attending physician.
- C. Ask the nurse why he has such feelings.
- D. Simply nod your head in agreement.
Correct Answer: A
Rationale: Protecting the patient's dignity and ensuring professionalism is paramount.