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The nurse is caring for a client who has just undergone a thyroidectomy. Which of the following complications should the nurse monitor for in the immediate postoperative period?
- A. Hypocalcemia.
- B. Hyperglycemia.
- C. Hypertension.
- D. Weight loss.
Correct Answer: A
Rationale: Hypocalcemia is a potential complication post-thyroidectomy due to accidental removal or damage to the parathyroid glands.
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A client with a history of type 2 diabetes mellitus is prescribed pioglitazone (Actos). The nurse should monitor the client for which of the following side effects?
- A. Hypoglycemia.
- B. Weight gain.
- C. Hypertension.
- D. Dry skin.
Correct Answer: B
Rationale: Pioglitazone can cause weight gain due to fluid retention, requiring monitoring in diabetic clients.
The nurse is assessing a client with suspected dehydration. Which of the following findings would support this diagnosis? Select all that apply.
- A. Sunken fontanelles in an infant.
- B. Tachycardia.
- C. Increased urine specific gravity.
- D. Dry skin.
- E. Hypotension.
Correct Answer: A, B, C, D, E
Rationale: Dehydration presents with sunken fontanelles, tachycardia, increased urine specific gravity, dry skin, and hypotension due to fluid loss.
The nurse is caring for a client with a diagnosis of peptic ulcer disease. When monitoring the client for possible gastrointestinal perforation, the nurse identifies the importance of what assessment data?
- A. Slow, strong pulses
- B. Increase in bowel sounds
- C. Positive guaiac stool tests
- D. Sudden, severe abdominal pain
Correct Answer: D
Rationale: Sudden, severe abdominal pain is a sign of perforation. When perforation occurs, the pulse will more likely be weak and rapid. The nurse may be unable to hear bowel sounds at all. Positive guaiac stool results indicate the presence of bleeding but are not necessarily indicative of perforation.
A client with chronic renal failure is receiving hemodialysis. Which dietary restriction should the nurse emphasize?
- A. Low-protein diet.
- B. High-sodium diet.
- C. Low-potassium diet.
- D. High-calcium diet.
Correct Answer: C
Rationale: A low-potassium diet is critical in chronic renal failure to prevent hyperkalemia, which can cause cardiac complications.
A client with metastatic cancer of the liver is concerned about his progress. Which of the following nursing interventions is most appropriate?
- A. Provide information for the client to consider a liver transplantation.
- B. Assure the client that the prescribed medications will shrink all tumor sites.
- C. Explain the effects of chemotherapy.
- D. Place emphasis on providing symptomatic and comfort measures.
Correct Answer: D
Rationale: For metastatic liver cancer, palliative care focusing on symptom relief and comfort is most appropriate, as transplantation or tumor shrinkage may not be feasible.