Nokea
If a client denies having a hearing impairment, which question would encourage them to respond?
- A. Do you always ask people to repeat questions? If so, do you think that you have a hearing problem?
- B. Are you cupping your ear for a reason? Do you have trouble hearing?
- C. Both A and B
- D. Neither A nor B
Correct Answer: C
Rationale: Asking open-ended questions increases the likelihood of acknowledgment and discussion of the issue.
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Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention?
- A. Platelet count.
- B. Electrolytes.
- C. Hemoglobin.
- D. Hematocrit.
Correct Answer: B
Rationale: Electrolyte imbalances, particularly hyperkalemia and hyperuricemia, are hallmark features of tumor lysis syndrome and must be closely monitored.
Your patient is often fatigued as a result of having anemia. She asks you why she is fatigued. You respond by saying
- A. Destruction (hemolysis) of the red blood cells.
- B. Paleness (pallor) of the skin.
- C. Lack of nutritional intake of essential nutrients, such as iron or B12.
- D. Decreased oxygen-carrying capability of the blood.
Correct Answer: D
Rationale: Anemia reduces the blood's ability to carry oxygen, leading to fatigue.
When a client is having a general tonic clonic seizure, the nurse should:
- A. Hold the client's arms at their side.
- B. Place the client on their side.
- C. Insert a padded tongue blade in client's mouth.
- D. Elevate the head of the bed.
Correct Answer: B
Rationale: Placing the client on their side prevents aspiration.
Derek has recently converted his outdoor garage to a gym. He has been exercising frequently in his new gym due to the convenience, even in the extreme heat. He has started taking salt tablets. The physician thinks his current symptoms may be owing to hypernatremia. His physician recognizes these as:
- A. Cardiac arrhythmias,palpitations and sinus arrest.
- B. Weakness,dizziness,abdominal distention, nausea ,vomiting, and diarrhea.
- C. Weight gain,irritability,muscle twitching and decreased myocardial contractility.
- D. Muscle cramps,malaise,constipation,rhabdomyolysis and pupillary constriction.
Correct Answer: B
Rationale: The correct answer is Weakness, dizziness, abdominal distention, nausea, vomiting, and diarrhea (B). Hypernatremia occurs when there is an excess of sodium in the body, often due to dehydration or excessive salt intake. Symptoms include gastrointestinal disturbances, neurological symptoms like confusion and dizziness, and muscle weakness.
A client with asthma is taking fluticasone. The nurse should monitor the client for which of the following adverse effects?
- A. Hypoglycemia
- B. Hypertension
- C. Polyuria
- D. Oral candidiasis
Correct Answer: D
Rationale: The correct answer is D: Oral candidiasis. Fluticasone is a corticosteroid inhaler that can cause oral candidiasis as a common adverse effect due to its immunosuppressive properties. The step-by-step rationale is: 1. Fluticasone is a corticosteroid. 2. Corticosteroids can suppress the immune system. 3. Immunosuppression can lead to oral candidiasis. Other choices are incorrect because: A: Hypoglycemia is not a common adverse effect of fluticasone. B: Hypertension is not typically associated with fluticasone use. C: Polyuria is not a common side effect of fluticasone.