Nokea
For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to the nursing assistant?
- A. Assist the patient to identify patterns of fatigue.
- B. Recommend participation in a walking program.
- C. Report the amount and type of food consumed from the tray.
- D. Check the skin for redness and irritation after the treatment.
Correct Answer: C
Rationale: Monitoring food intake is a straightforward task suitable for a nursing assistant, while identifying fatigue patterns or recommending exercise requires more clinical expertise.
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What would be the best response by the nurse to a quiet and uncommunicative client?
- A. Think over the following questions.
- B. Discuss them with your instructor or peers.
- C. Acknowledge their feelings and encourage expression.
- D. Offer silence and wait patiently.
Correct Answer: D
Rationale: Silence can provide the client with space to open up when they feel ready, fostering trust and rapport.
Which of the following is a finding that is most often associated with endometrial cancer?
- A. Thickened endometrial lining on ultrasound
- B. Irregular periods
- C. Young age
- D. Dyspareunia
Correct Answer: A
Rationale: A thickened endometrial lining on ultrasound is commonly associated with endometrial cancer, indicating abnormal cell growth.
When teaching a client with chronic obstructive pulmonary disease who will start using fluticasone via MDI twice daily, which instruction should the nurse include?
- A. Monitor your heart rate before each dose.
- B. Inspect your mouth for lesions daily.
- C. Do not use this medication to relieve an acute attack.
- D. Do not skip the morning dose even if symptom-free.
Correct Answer: B
Rationale: The correct answer is B: Inspect your mouth for lesions daily. This instruction is essential because fluticasone, a corticosteroid, can cause oral thrush as a side effect. By inspecting the mouth daily, the client can detect any lesions early and seek appropriate treatment. Monitoring heart rate (A) is not necessary for fluticasone use, as it does not typically affect heart rate. While it is important not to skip doses (D), the specific instruction about the morning dose is not as crucial. Avoiding the use of fluticasone for acute attacks (C) is correct, but it is not the most important instruction in this scenario.
What does progression of patients through various phases of care in a postanesthesia care unit (PACU) primarily depend on?
- A. Condition of patient
- B. Type of anesthesia used
- C. Preference of surgeon
- D. Type of surgical procedure
Correct Answer: A
Rationale: Patient condition dictates the progression through PACU phases, ensuring appropriate care levels.
What is the first sign that the condition of a dying client is worsening?
- A. Pulmonary function impairment
- B. Peripheral circulation changes
- C. Central nervous system alterations
- D. Failing cardiac function
Correct Answer: C
Rationale: Central nervous system changes, such as confusion or lethargy, often indicate declining health in terminal stages.