Nokea
The client presents to the emergency room with a 'bull's eye' rash. Which question would be most appropriate for the nurse to ask the client?
- A. Have you found any ticks on your body?'
- B. Have you had any nausea in the last 24 hours?'
- C. Have you been outside the country in the last 6 months?'
- D. Have you had any fever for the past few days?'
Correct Answer: A
Rationale: A bull's eye rash is characteristic of Lyme disease, often caused by tick bites, making this the most relevant question.
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The nurse is caring for a client with peripheral vascular disease. To correctly assess the oxygen saturation level, the monitor may be placed on the:
- A. Hip
- B. Ankle
- C. Earlobe
- D. Chin
Correct Answer: C
Rationale: The earlobe is a suitable site for pulse oximetry in peripheral vascular disease, as it is less affected by impaired peripheral circulation.
The nurse is teaching a client with a new colostomy about dietary management. Which of the following foods should the nurse recommend the client avoid to reduce odor and gas?
- A. Broccoli.
- B. Baked chicken.
- C. Rice.
- D. Yogurt.
Correct Answer: A
Rationale: broccoli is a gas-forming food that can increase odor and gas in a colostomy
A client has been hospitalized with a diagnosis of laryngeal cancer. Which factor is most significant in the development of laryngeal cancer?
- A. A family history of laryngeal cancer
- B. Chronic inhalation of noxious fumes
- C. Frequent straining of the vocal cords
- D. A history of frequent alcohol and tobacco use
Correct Answer: D
Rationale: Frequent alcohol and tobacco use is the most significant risk factor for laryngeal cancer due to chronic irritation and carcinogenic effects on laryngeal tissues.
Which clinical manifestation during the actual bone marrow transplantation alerts you to the possibility of an adverse reaction?
- A. Fever
- B. Red urine
- C. Hypertension
- D. Shortness of breath
Correct Answer: D
Rationale: Shortness of breath during bone marrow transplantation may indicate an anaphylactic or transfusion reaction, requiring immediate intervention.
A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The nurse's discharge teaching should include:
- A. Telling the client's wife not to touch the tablets
- B. Explaining that the medication should be taken with meals
- C. Telling the client that symptoms will improve in 1-2 weeks
- D. Instructing the client to take the medication at bedtime, to prevent nocturia
Correct Answer: A
Rationale: Finasteride tablets should not be handled by pregnant women due to the risk of fetal harm. This is a critical teaching point for safety.