Nokea
The daughter of a 70-year-old patient with cancer asks the nurse, 'Do you believe in euthanasia?' Which of the following responses by the nurse is BEST?
- A. I think that each person has to decide this issue for herself.
- B. My religion is opposed to euthanasia.
- C. What are your thoughts about euthanasia?
- D. Did you see the TV program about euthanasia last night?
Correct Answer: C
Rationale: open-ended question, allows client to verbalize
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The nurse is caring for a client with a new tracheostomy.
- A. What is the priority nursing intervention for a client with a new tracheostomy?
- B. Suction the tracheostomy every 2 hours.
- C. Change the tracheostomy ties daily.
- D. Monitor the stoma for signs of infection.
- E. Keep the tracheostomy cuff inflated at all times.
Correct Answer: C
Rationale: Monitoring the stoma for signs of infection is the priority to detect complications early, ensuring airway safety. Suctioning is as needed, ties are changed as needed, and continuous cuff inflation risks tracheal damage.
The nurse is teaching a client with a new diagnosis of Parkinson’s disease about levodopa-carbidopa (Sinemet). Which of the following instructions should the nurse include?
- A. Take the medication with a high-protein meal
- B. Report any uncontrolled movements
- C. Stop the medication if symptoms improve
- D. Avoid regular neurological exams
Correct Answer: B
Rationale: Uncontrolled movements, such as dyskinesias, are a side effect of levodopa-carbidopa, requiring dose adjustment. Options A, C, and D are incorrect: high-protein meals reduce absorption, stopping the medication risks symptom return, and exams are essential.
A 36-year-old man has a flaccid bladder following a spinal cord injury. The nurse is teaching the client about dietary changes. Which of the following beverages, if selected by the client, would indicate to the nurse that teaching was effective?
- A. Lemonade.
- B. Prune juice.
- C. Milk.
- D. Orange juice.
Correct Answer: B
Rationale: promotes acidic urine, minimizes risk of urinary tract infection and stone formation, also use cranberry, tomato juice, bouillon
The nurse in the outpatient clinic teaches a young adult with a sprained right ankle to walk with a cane. While teaching the client to use the cane, how should the nurse be positioned?
- A. Standing on the client's left side and slightly behind the client.
- B. Standing on the client's right with one hand on the client's waist.
- C. Standing directly in front of the woman with both hands on the client's arms.
- D. Standing in front of the client on the right side.
Correct Answer: A
Rationale: stand slightly behind patient on strong side
A client has received thrombolytic therapy, and the physician has ordered meperidine (Demerol) IM for pain. Before administering the injection, the nurse should
- A. confirm that all lab work has been completed.
- B. verify the order with the physician.
- C. check the client's PTT.
- D. determine that all of the thrombolytic agent has infused.
Correct Answer: B
Rationale: implementation, complications of thrombolytic therapy include bleeding, which can occur with intramuscular injections; nurse should confer with the physician about the appropriateness of the order