Nokea
The nurse is assessing a client who is suspected of having a diagnosis of testicular cancer. Which data will be most helpful for determining the client's risk for this type of cancer?
- A. Race
- B. Marital status
- C. Number of children
- D. Number of sexual partners
Correct Answer: A
Rationale: Race is a key risk factor for testicular cancer, with higher incidence in White males compared to other groups. Marital status, number of children, and sexual partners are not established risk factors for this cancer.
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A client who is taking tranylcypromine sulfate requests information about foods that are acceptable to eat while taking the medication. Which foods are safe to consume while taking this medication?
- A. Yogurt
- B. Raisins
- C. Oranges
- D. Smoked fish
Correct Answer: C
Rationale: Tranylcypromine sulfate is classified as a monoamine oxidase inhibitor (MAOI); as such, tyramine-containing food should be avoided. Oranges are permissible. Types of food to be avoided include—but are not limited to—yogurt, raisins, and smoked fish. Additionally, beer, wine, caffeinated beverages, pickled meats, yeast preparations, avocados, bananas, and plums are to be avoided.
A nurse working in the neonatal intensive care unit (NICU) teaches handwashing techniques to the parents of an infant who is receiving antibiotic treatment for a neonatal infection. The nurse determines that the parents understand the primary purpose of hand washing if which statement is made?
- A. It is primarily done to reduce their fears.
- B. It is primarily done to minimize the spread of infection to other siblings.
- C. It is primarily done to allow them an opportunity to communicate with each other and staff.
- D. It is primarily done to reduce the possibility of transmitting an environmental infection to the infant.
Correct Answer: D
Rationale: Appropriate hand washing by staff and parents has been effective for the prevention of nosocomial infections in nursery units. This action also promotes parents taking an active part in the care of their infant. Reducing fears and encouraging communication are not the primary reasons to perform hand washing. Because the infant already has an infection and is in the NICU, transference to siblings is not the best choice.
The nurse is giving instructions to an adult client with heart failure who is beginning therapy with digoxin. To detect early complications of therapy, which action should the nurse teach the client to perform?
- A. Take the pulse daily.
- B. Have electrolyte levels drawn weekly.
- C. Monitor the blood pressure once a week.
- D. Measure the weight each morning before breakfast.
Correct Answer: A
Rationale: Daily pulse monitoring helps detect digoxin-related complications like bradycardia (pulse <60 beats/min) or tachycardia (>100 beats/min), which require provider notification. Weekly electrolyte levels, blood pressure monitoring, and daily weight are not specific to early digoxin complications.
The nurse has conducted teaching, with a client who experienced pulmonary embolism, about methods to prevent recurrence after discharge. Which client statement demonstrates understanding of the teaching?
- A. I will limit the intake of fluids.
- B. I will sit down whenever possible.
- C. I am planning to continue to wear supportive hose.
- D. I will cross my legs only at the ankle and not at the knees.
Correct Answer: C
Rationale: Wearing supportive hose enhances venous return, reducing the risk of thrombus formation and pulmonary embolism recurrence. Limiting fluid intake can lead to hemoconcentration, increasing clot risk. Prolonged sitting or crossing legs (even at the ankles) can impede venous return and should be avoided.
The nurse has given the client with a nonplaster (fiberglass) leg cast instructions regarding cast care at home. The nurse determines that the client needs further teaching if the client makes which statement?
- A. I should avoid walking on wet, slippery floors.
- B. I'm not supposed to scratch the skin underneath the cast.
- C. It's all right to wipe dirt off of the top of the cast with a damp cloth.
- D. If the cast gets wet, I can dry it with a hair dryer turned to the hot setting.
Correct Answer: D
Rationale: Using a hair dryer on a hot setting to dry a wet fiberglass cast can cause burns or damage the cast. Avoiding slippery floors, not scratching under the cast, and wiping the cast with a damp cloth are correct care instructions.