Nokea
The nurse is assessing a client with macular degeneration. Identify the illustration that best depicts what clients with this disorder typically see
- A. degeneration-1.png
- B. degeneration-2.png
- C. degeneration-3.png
- D. degeneration-4.png
Correct Answer: C
Rationale: In macular degeneration the center vision is blackened out and only the outer visual fields are clear.
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Which of the following medications should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy?
- A. Sodium phosphate.
- B. Calcium gluconate.
- C. Echothiophate iodide.
- D. Sodium bicarbonate.
Correct Answer: B
Rationale: Calcium gluconate is used to treat tetany by correcting hypocalcemia, which causes muscle spasms and tingling.
Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply.
- A. Avoid turning the toes or knee outward.
- B. Use an abduction pillow between the legs when in bed.
- C. Use an elevated toilet seat and shower chair.
- D. Do not extend the operative leg backwards.
- E. Restrict motion for 2 weeks after surgery.
Correct Answer: A,B,C,D
Rationale: These measures prevent dislocation and promote recovery. Motion is encouraged, not restricted, to aid rehabilitation.
A client with Raynaud's phenomenon is prescribed diltiazem (Cardizem). An expected outcome is:
- A. Decreased heart rate
- B. A return to normal sinus rhythm
- C. Reduced episodes of finger numbness
- D. Increased SpO2
Correct Answer: C
Rationale: Diltiazem, a calcium channel blocker, reduces vasospasm in Raynaud's by promoting vasodilation, decreasing episodes of finger numbness. It may lower heart rate or affect rhythm, but these are not primary goals, and SpO2 is not directly improved.
A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used?
- A. The client exhibits intolerance to many drugs.
- B. The client experiences spontaneous remissions from time to time.
- C. The client requires multiple drugs simultaneously.
- D. The client endures long periods of exacerbation before the illness responds to a particular drug.
Correct Answer: B
Rationale: Spontaneous remissions in MS make it challenging to attribute symptom improvement to drugs versus natural disease course. Intolerance, multiple drugs, or delayed responses are less primary factors.
A client has the following arterial blood gas values: pH, 7.52; PaO2, 50 mm Hg; PaCO2, 28 mm Hg; HCO3ˆ’, 24 mEq/L. The nurse determines that which of the following is a possible cause for these findings?
- A. Chronic obstructive pulmonary disease (COPD).
- B. Diabetic ketoacidosis with Kussmaul's respirations.
- C. Myocardial infarction.
- D. Pulmonary embolus.
Correct Answer: D
Rationale: The ABG shows respiratory alkalosis (high pH, low PaCO2) and severe hypoxia (PaO2 50). Pulmonary embolus causes hypoxia and hyperventilation, matching these findings. COPD causes CO2 retention. Ketoacidosis causes metabolic acidosis. Myocardial infarction is less likely to cause this pattern.