Nokea
The healthcare provider in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing?
- A. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96
- B. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy
- C. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease
- D. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea
Correct Answer: C
Rationale: The correct answer is C. The patient with a sibling having newly diagnosed polycystic kidney disease may need a referral for genetic testing. Polycystic kidney disease has a genetic component, so there is a higher likelihood of the patient also having the condition. Referral for genetic testing can help in early diagnosis, management, and counseling for the patient and their family members.
Choice A is incorrect because strokes in maternal grandparents at advanced ages are not typically indicative of a need for genetic testing. Choice B is incorrect as cerebral palsy is not typically a genetic condition related to the patient's pregnancy test result. Choice D is incorrect as dyspnea in a smoking patient is more likely related to respiratory issues such as chronic obstructive pulmonary disease rather than a genetic condition.
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The community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?
- A. The mother who took her children from school because aliens were after them.
- B. The young man who has a history of substance abuse and no telephone.
- C. The newly diagnosed client who needs to be evaluated for medication compliance.
- D. The young woman who believes she is to blame for her recent miscarriage.
Correct Answer: A
Rationale: The correct answer is A: The mother who took her children from school because aliens were after them should be seen first. This choice indicates potential harm to the children due to the mother's delusions, posing an immediate safety concern. The nurse needs to assess the situation and ensure the children's safety. Choices B, C, and D do not present immediate safety risks. B is a history of substance abuse but no current immediate danger. C is newly diagnosed and can wait for evaluation, as can D who may need support but is not in immediate danger. Prioritizing safety is crucial in mental health nursing.
A patient who is receiving chemotherapy for breast cancer develops thrombocytopenia. What should the nurse include in the care plan?
- A. Encourage light exercise.
- B. Avoid intramuscular injections.
- C. Do not administer aspirin.
- D. Use a soft toothbrush for oral care.
Correct Answer: B
Rationale: The correct answer is B: Avoid intramuscular injections. Thrombocytopenia is a condition characterized by low platelet count, which can lead to impaired blood clotting. Intramuscular injections can cause bleeding and bruising due to the decreased ability of blood to clot. Therefore, it is crucial to avoid invasive procedures like intramuscular injections to prevent excessive bleeding in patients with thrombocytopenia. Encouraging light exercise (choice A) can be beneficial for overall health but may not directly address the risk of bleeding. Avoiding aspirin (choice C) is important as it can further increase the risk of bleeding. Using a soft toothbrush for oral care (choice D) is a good practice, but it does not directly address the risk associated with intramuscular injections in patients with thrombocytopenia.
A client with type 1 diabetes mellitus is experiencing nausea and vomiting. What advice should the nurse give regarding insulin administration?
- A. Skip your insulin dose until you can eat.'
- B. Take your insulin as prescribed, but monitor your blood glucose closely.'
- C. Reduce your insulin dose by half.'
- D. Only take your long-acting insulin.'
Correct Answer: B
Rationale: The correct answer is B because skipping insulin can lead to dangerous complications like diabetic ketoacidosis. Taking insulin as prescribed ensures blood glucose control, preventing hyperglycemia. Monitoring blood glucose closely helps adjust doses accordingly. Choice A is incorrect as skipping insulin can be life-threatening. Choice C is incorrect as reducing insulin without proper monitoring can lead to unstable glucose levels. Choice D is incorrect as both long-acting and short-acting insulin are essential for managing type 1 diabetes.
The patient has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?
- A. Maintain the patient on bed rest.
- B. Auscultate lung sounds every 4 hours.
- C. Monitor for Trousseau's and Chvostek's signs.
- D. Encourage fluid intake up to 4000 mL every day.
Correct Answer: D
Rationale: The correct answer is D: Encourage fluid intake up to 4000 mL every day. High calcium levels can lead to dehydration, so encouraging fluid intake helps prevent this complication. Increased fluid intake also promotes calcium excretion through urine. Bed rest (A) is not directly related to managing high calcium levels. Auscultating lung sounds (B) every 4 hours is more relevant for respiratory issues. Monitoring for Trousseau's and Chvostek's signs (C) is associated with low calcium levels, not high levels.
A patient with rheumatoid arthritis is prescribed methotrexate. What should the nurse include in the patient teaching?
- A. Take folic acid supplements as prescribed.
- B. Avoid alcohol completely.
- C. Expect to see immediate results.
- D. Limit fluid intake to 1 liter per day.
Correct Answer: A
Rationale: The correct answer is A: Take folic acid supplements as prescribed. Methotrexate can lead to folic acid deficiency, so supplementing with folic acid helps prevent side effects. It is important for the nurse to educate the patient on the importance of taking folic acid to maintain overall health.
Choice B is incorrect. While it is generally recommended to limit alcohol consumption with methotrexate, avoiding it completely may not be necessary for all patients.
Choice C is incorrect. Methotrexate takes time to work, often several weeks to months, so immediate results should not be expected.
Choice D is incorrect. Limiting fluid intake to 1 liter per day is not a standard recommendation for patients taking methotrexate. Adequate hydration is important for overall health.