Nokea
The client with AIDS tells the nurse that he has been using acupuncture to help with his pain. The nurse should question the client regarding this treatment because acupuncture uses:
- A. Pressure from the fingers and hands to stimulate the energy points in the body
- B. Oils extracted from plants and herbs
- C. Needles to stimulate certain points on the body to treat pain
- D. Manipulation of the skeletal muscles to relieve stress and pain
Correct Answer: C
Rationale: Acupuncture uses needles, which pose an infection risk in immunocompromised AIDS patients, requiring further discussion.
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A client with AIDS has a viral load of 200 copies per ml. The nurse should interpret this finding as:
- A. The client is at risk for opportunistic diseases.
- B. The client is no longer communicable.
- C. The client's viral load is extremely low so he is relatively free of circulating virus.
- D. The client's T-cell count is extremely low.
Correct Answer: C
Rationale: A viral load of 200 copies/ml is low, indicating effective treatment and minimal circulating virus.
The nurse is caring for a client with a long history of taking magnesium hydroxide for managing symptoms of peptic ulcer disease. Which finding in the client's medical history would be of concern to the nurse?
- A. asthma
- B. arthritis
- C. heart failure
- D. enlarged prostate
Correct Answer: C
Rationale: Magnesium hydroxide can cause fluid retention, worsening heart failure. Other conditions are not directly affected.
A client requires insertion of a nasogastric tube. When preparing the client for the procedure, the nurse should place the client in which of the following positions?
- A. High Fowler's position with the head tilted forward.
- B. High Fowler's position with the head tilted backward.
- C. Semi-Fowler's position with the head in a neutral position.
- D. Semi-Fowler's position with the head tilted backward.
Correct Answer: A
Rationale: High Fowler's position with the head tilted forward (A) facilitates nasogastric tube insertion by aligning the esophagus and reducing the risk of aspiration. Tilting the head backward (B, D) or using a neutral position in semi-Fowler's (C) is less effective for this procedure.
A client with primary sclerosing cholangitis has received a liver transplant. The nurse should give priority to assessing the client for complications. Which findings are associated with an acute rejection of the new liver?
- A. Increased jaundice and prolonged prothrombin time
- B. Fever and foul-smelling bile drainage
- C. Abdominal distention and clay-colored stools
- D. Increased uric acid and increased creatinine
Correct Answer: A
Rationale: Increased jaundice and prolonged prothrombin time indicate liver dysfunction, consistent with acute liver transplant rejection.
After a cardiac catheterization procedure, the nurse should ask the client to remain in which position?
- A. on the left side, with both knees bent slightly
- B. semi-Fowler's position
- C. supine with a small pillow under the head
- D. high-Fowler's position
Correct Answer: C
Rationale: The supine position with a small pillow under the head promotes comfort and prevents bleeding from the catheter insertion site (usually femoral) after cardiac catheterization.