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The nurse has received a prescription for tenofovir and emtricitabine. The nurse understands that this medication is used to treat
- A. multiple sclerosis.
- B. human immunodeficiency virus (HIV).
- C. Parkinson's disease.
- D. Guillain-Barré syndrome.
Correct Answer: B
Rationale: Tenofovir and emtricitabine (Truvada) are antiretroviral medications used to treat and prevent HIV. They are not used for multiple sclerosis (A), Parkinson’s disease (C), or Guillain-Barré syndrome (D).
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The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate?
- A. Peripheral edema.
- B. Ascites.
- C. Anorexia.
- D. Jaundice.
Correct Answer: D
Rationale: Jaundice (D) is a common early sign of cirrhosis due to impaired bilirubin metabolism. Peripheral edema (A) and ascites (B) occur later. Anorexia (C) is less specific.
The nurse is planning care with a client with acute leukemia who has mucositis. The nurse should advise the client that after every meal and every four hours while awake the client should use:
- A. Lemon-glycerin swabs.
- B. A commercial mouthwash.
- C. A saline or baking soda solution.
- D. A commercial toothpaste and brush.
Correct Answer: C
Rationale: Mucositis in leukemia clients requires gentle oral care to prevent infection and promote healing. Saline or baking soda solution is soothing and non-irritating. Lemon-glycerin swabs can dry the mucosa, commercial mouthwash may irritate, and brushing may cause trauma.
Which medication is prescribed to prevent uric acid stones?
- A. Hydrochlorothiazide.
- B. Allopurinol.
- C. Potassium citrate.
- D. Acetaminophen.
Correct Answer: B
Rationale: Allopurinol reduces uric acid levels, preventing stone formation.
The nurse assesses a client with a below-knee amputation for prosthetic fitting. Which finding indicates readiness for a prosthesis?
- A. Full range of motion in the residual limb.
- B. Absence of pain in the stump.
- C. Healed incision with no drainage.
- D. Presence of mild edema in the stump.
Correct Answer: C
Rationale: A healed incision without drainage is essential for safe prosthetic fitting to prevent skin breakdown.
The client who has been hospitalized with pancreatitis does not drink alcohol because of her religious convictions. She becomes upset when the physician persists in asking her about alcohol intake. The nurse should explain that the reason for these questions is that:
- A. There is a strong link between alcohol use and acute pancreatitis.
- B. Alcohol intake can interfere with the tests used to diagnose pancreatitis.
- C. Alcoholism is a major health problem, and all clients are questioned about alcohol intake.
- D. The physician must obtain the pertinent facts, regardless of religious beliefs.
Correct Answer: A
Rationale: Alcohol is a primary cause of acute pancreatitis, so questioning its use (A) is essential to identify etiology. Interference with tests (B), general alcoholism screening (C), or disregarding beliefs (D) are not accurate explanations.