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A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include?
- A. The client will walk for 30 min 5 days a week.
- B. The client will quit smoking within 2 weeks.
- C. The client will reduce BMI to 22 in 6 months.
- D. The client will eat low-fat meals every day.
Correct Answer: A
Rationale: The correct answer is A: The client will walk for 30 min 5 days a week. Walking is a feasible and effective form of exercise for overall health promotion. It helps improve cardiovascular health, which is important for someone with hypertension. It also aids in weight management, addressing the client's elevated BMI. Additionally, it can assist in smoking cessation efforts by reducing cravings and stress. Quitting smoking (choice B) is crucial but may require a longer timeline. Reducing BMI to 22 in 6 months (choice C) may be too aggressive and unrealistic. Eating low-fat meals (choice D) is beneficial but focusing solely on diet may not address the client's overall health needs.
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A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority?
- A. Defibrillation
- B. Administer oxygen
- C. Call for help
- D. Start chest compressions
Correct Answer: A
Rationale: The correct answer is A: Defibrillation. Ventricular fibrillation is a life-threatening arrhythmia that requires immediate defibrillation to restore the heart's normal rhythm. Defibrillation is the priority as it is the most effective intervention to treat ventricular fibrillation and increase the chance of survival. Administering oxygen (B) is important but not the priority over defibrillation. Calling for help (C) should be done after initiating defibrillation. Starting chest compressions (D) should only be done if defibrillation is not immediately available or unsuccessful.
A nurse is teaching a middle-aged client about hypertension. Which of the following information should the nurse include in the teaching?
- A. Calcium channel blockers are the first choice for hypertension.
- B. Beta-blockers are the first type of medication for hypertension.
- C. ACE inhibitors are the first choice for hypertension.
- D. Diuretics are the first type of medication to control hypertension.
Correct Answer: A
Rationale: Diuretics are the first-line treatment for hypertension as they reduce blood volume, lowering blood pressure.
A nurse is teaching a class about preventive care to clients who are at risk for acquiring viral hepatitis. Which of the following information should the nurse include in the presentation?
- A. Avoid foods prepared with tap water.
- B. Use purified water for drinking.
- C. Limit intake of fried foods.
- D. Get vaccinated for hepatitis C.
Correct Answer: A
Rationale: The correct answer is A: Avoid foods prepared with tap water. Tap water in certain regions may be contaminated with hepatitis-causing viruses. Using bottled or purified water for drinking alone (choice B) may not prevent exposure through food preparation. Limiting fried foods (choice C) is unrelated to preventing viral hepatitis. While getting vaccinated for hepatitis C (choice D) is important, it is not directly related to preventing exposure through contaminated tap water. Therefore, the most effective preventive measure is to avoid foods prepared with tap water to reduce the risk of acquiring viral hepatitis.
A nurse is reviewing the laboratory findings for a client who developed fat embolism syndrome (FES) following a fracture. Which of the following laboratory findings should the nurse expect?
- A. Decreased serum calcium level
- B. Increased potassium level
- C. Decreased white blood cell count
- D. Increased serum albumin level
Correct Answer: A
Rationale: The correct answer is A: Decreased serum calcium level. In fat embolism syndrome (FES), fat droplets enter the bloodstream and can affect various organs. One of the common complications is hypocalcemia due to the binding of calcium to the fatty acids, leading to decreased serum calcium levels. This can result in symptoms such as confusion, tetany, and seizures. The other choices are incorrect because: B: Increased potassium level is not typically associated with FES. C: Decreased white blood cell count is not a common finding in FES. D: Increased serum albumin level is not related to FES.
A nurse is providing teaching to a client who has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine cancer. Which of the following instructions should the nurse include in the teaching?
- A. Artificial lubrication can be used to treat vaginal itching and dryness.
- B. Estrogen therapy will reverse vaginal dryness.
- C. Do not use tampons for 6 months.
- D. Avoid sexual activity for 1 year.
Correct Answer: A
Rationale: Correct Answer: A. Artificial lubrication can be used to treat vaginal itching and dryness.
Rationale: After a total abdominal hysterectomy and bilateral salpingo-oophorectomy, the client will experience menopausal symptoms due to the removal of the ovaries. Vaginal dryness and itching are common symptoms that can be managed with artificial lubrication. Estrogen therapy is contraindicated in this client due to the history of uterine cancer. Using tampons can increase the risk of infection post-surgery. Avoiding sexual activity for 1 year is not necessary unless advised by the healthcare provider.