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The client with lymphedema has an increased risk of cellulitis and lymphangitis because of:
- A. Fragility of the capillaries.
- B. Myelosuppression of the bone marrow.
- C. Stagnation of accumulated fluid.
- D. Increased use of the extremity.
Correct Answer: C
Rationale: Stagnation of accumulated fluid in lymphedema creates an environment conducive to bacterial growth, increasing the risk of cellulitis and lymphangitis.
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A client with renal calculi has hematuria. The nurse should:
- A. Monitor urine output.
- B. Notify the physician immediately.
- C. Restrict fluids.
- D. Apply ice to the flank.
Correct Answer: A
Rationale: Hematuria is expected with renal calculi; monitoring ensures no excessive bleeding.
Which of the following interventions will be most effective in improving transcultural communications with the client?
- A. Use touch to show concern and caring for the client.
- B. Focus attention on verbal communication skills only.
- C. Establish a rapport and listen to their concerns.
- D. Maintain eye contact at all times.
Correct Answer: C
Rationale: Establishing rapport and listening to concerns fosters trust and understanding, which are essential for effective transcultural communication.
Which symptom suggests bladder cancer recurrence?
- A. Painful urination.
- B. Frequent urination.
- C. Hematuria.
- D. Nocturia.
Correct Answer: C
Rationale: Hematuria is a common sign of bladder cancer recurrence.
The nurse is preparing to administer an intramuscular (IM) injection to a neonate. Which gauge and size needle should the nurse use to administer the medication?
- A. 19 gauge, 1 1/2" (3.8 cm) needle
- B. 18 gauge, 1" (2.5 cm) needle
- C. 20 gauge, 1" (2.5 cm) needle
- D. 25 gauge, 5/8" (1.6 cm) needle
Correct Answer: D
Rationale: A 25-gauge, 5/8" needle is appropriate for neonates due to their small muscle mass and thin subcutaneous tissue, minimizing trauma.
The nurse should assess the client with bladder cancer for which of the following?
- A. Suprapubic pain.
- B. Dysuria.
- C. Painless hematuria.
- D. Urine retention.
Correct Answer: C
Rationale: Painless hematuria is a hallmark symptom of bladder cancer, often presenting as the initial sign due to tumor growth causing bleeding without associated pain.