Nokea
The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?
- A. Serum calcium.
- B. Serum phosphorus.
- C. Serum potassium.
- D. Serum sodium.
Correct Answer: C
Rationale: Vomiting and diarrhea cause significant potassium loss, leading to hypokalemia, which can cause arrhythmias. Calcium, phosphorus, and sodium are less critically affected in this scenario.
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When asked about factors that are linked to bladder cancer, the nurse correctly identifies which factors? Select all that apply.
- A. Stress incontinence
- B. Frequent intercourse
- C. Sexual promiscuity
- D. Cigarette smoking
- E. History of prostate cancer
- F. Exposure to asbestos
Correct Answer: D
Rationale: Cigarette smoking is a well-established risk factor for bladder cancer.
The elderly client being seen in the clinic has complaints of urinary frequency, urgency, and 'leaking.' Which priority intervention should the nurse implement when interviewing the client?
- A. Ensure communication is nonjudgmental and respectful.
- B. Set the temperature for comfort in the examination room.
- C. Speak loudly to ensure the client understands the nurse.
- D. Ensure the examining room has adequate lighting.
Correct Answer: A
Rationale: Nonjudgmental, respectful communication builds trust, encouraging the elderly client to discuss sensitive incontinence issues openly. Comfort, loud speech, and lighting are secondary to effective communication.
After the cystoscopy, which urinary symptom can the nurse expect the client to report?
- A. A sense of urgency
- B. No urinary output
- C. A strong urinary odor
- D. A large volume of urine output
Correct Answer: A
Rationale: A sense of urgency is common after cystoscopy due to urethral irritation from the procedure.
The nurse is caring for a client with a TURP. Which expected outcome indicates the client’s condition is improving?
- A. The client is using the maximum amount allowed by the PCA pump.
- B. The client’s bladder spasms are relieved by medication.
- C. The client’s scrotum is swollen and tender with movement.
- D. The client has passed a large, hard, brown stool this morning.
Correct Answer: B
Rationale: Relief of bladder spasms indicates reduced irritation and healing post-TURP. Maximum PCA use, scrotal swelling, or hard stools do not reflect improvement and may indicate complications.
The female client diagnosed with bladder cancer who has a cutaneous urinary diversion states, 'Will I be able to have children now?' Which statement is the nurse’s best response?
- A. Cancer does not make you sterile, but sometimes the therapy can.'
- B. Are you concerned you can’t have children?'
- C. You will be able to have as many children as you want.'
- D. Let me have the chaplain come to talk with you about this.'
Correct Answer: A
Rationale: Bladder cancer itself does not cause sterility, but treatments (e.g., chemotherapy, radiation) may affect fertility. This response is accurate and informative. Reflecting concern, promising fertility, or referring to a chaplain avoids the question.