Nokea
The HCP has recommended a total laryngectomy for a male client diagnosed with cancer of the larynx but the client refuses. Which intervention by the nurse illustrates the ethical principle of nonmalfeasance?
- A. The nurse listens to the client explain why he is refusing surgery.
- B. The nurse and significant other insist that the client have the surgery.
- C. The nurse refers the client to a counselor for help with the decision.
- D. The nurse asks a cancer survivor to come and discuss the surgery with the client.
Correct Answer: A
Rationale: Listening to the client’s reasons (A) respects autonomy and avoids harm (nonmalfeasance). Insisting (B), counseling (C), and survivor talks (D) may pressure or influence unduly.
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You're educating a patient about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the patient require you to re-educate them about how this medication works? Select all that apply:
- A. This medication will help dissolve the blood clot.
- B. This medication will prevent another blood clot from forming.
- C. This medication will help prevent the blood clot from becoming bigger in size.
- D. This medication starts working immediately after the first dose.
Correct Answer: A,D
Rationale: Warfarin (Coumadin) does NOT dissolve blood clots. It prevents blood clots from forming, and if one is present, it will help prevent it from becoming bigger. If the blood clot becomes bigger it may break off and travel in blood circulation. This can lead to a pulmonary embolism, heart attack, or stroke. Warfarin (Coumadin) does NOT start working immediately. It takes about 3-5 days of scheduled doses to start achieving a therapeutic INR level. It is very common that a patient will be on Heparin while taking Warfarin until INR levels are therapeutic.
The nurse is caring for the client diagnosed with bacterial pneumonia. Which priority intervention should the nurse implement?
- A. Assess respiratory rate and depth.
- B. Provide for adequate rest period.
- C. Administer oxygen as prescribed.
- D. Teach slow abdominal breathing.
Correct Answer: C
Rationale: Administering oxygen as prescribed (C) is the priority for bacterial pneumonia to address hypoxemia, a common issue due to impaired gas exchange. Assessing respiratory rate (A) is important but secondary to ensuring oxygenation. Rest (B) and breathing techniques (D) support recovery but are not the first priority.
Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
- A. Stridor
- B. Coarse crackles
- C. Oxygen saturation less than $90 \%$
- D. Non-productive, nagging cough
- E. Elevated white blood cells
- F. Low PCO2 of less than 35
- G. Tachypnea
Correct Answer: B,C,E,G
Rationale: Pneumonia typically presents with coarse crackles due to fluid in alveoli, low oxygen saturation from impaired gas exchange, elevated WBCs indicating infection, and tachypnea (G) as a compensatory mechanism. Stridor is associated with upper airway obstruction, non-productive cough is less common, and low PCO2 suggests hyperventilation, not typical.
Which statement by the client best indicates that the client understands the rationale for the direct laryngoscopy?
- A. The test will tell if my hoarseness is caused by tracheal polyps.
- B. The physician says that hoarseness can lead to bronchitis.
- C. I need to have the test because hoarseness is a symptom of laryngeal cancer.
- D. The physician wants to see if my hoarseness is because of enlarged tonsils.
Correct Answer: C
Rationale: Persistent hoarseness can be a symptom of laryngeal cancer, and direct laryngoscopy is used to visualize the larynx for abnormalities like tumors.
The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a surgical floor. Which information provided by the UAP requires immediate intervention by the nurse?
- A. There is a small, continuous amount of bright-red drainage coming out from under the dressing of the client who had a radical neck dissection.
- B. The client who has had a right upper lobectomy is complaining that the patient-controlled analgesia (PCA) pump is not providing any relief.
- C. The client diagnosed with cancer of the lung is complaining of being tired and short of breath.
- D. The client admitted with chronic obstructive pulmonary disease is making a whistling sound with every breath.
Correct Answer: A
Rationale: Bright-red drainage post-neck dissection (A) suggests hemorrhage, requiring immediate action. PCA failure (B), fatigue/SOB (C), and wheezing (D) are expected or less urgent.