Nokea
The nurse is caring for a client who tests positive for the sexually transmitted infection (STI) gonorrhea. The client reports having sex with someone who has many partners. Which response should the nurse provide?
- A. Teach importance of medication regimen and follow-up protocol.
- B. Discuss that partners without similar symptoms may not be infected.
- C. Emphasize that using safe sex practices removes the risk of STIs.
- D. Clarify that all STIs are transmitted through sexual intercourse.
Correct Answer: A
Rationale: Teaching the importance of medication regimen and follow-up protocol is crucial for treating gonorrhea and preventing its spread.
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Which findings during the admission assessment should the nurse document that are related to a client diagnosed with Cushing's syndrome?
- A. Husky voice and troubled by hoarseness.
- B. Central type obesity, with thin extremities.
- C. Warm, soft, moist, salmon colored skin.
- D. Visible swelling of the neck, with no pain.
Correct Answer: B
Rationale: Central type obesity with thin extremities is a classic manifestation of Cushing's syndrome due to excess cortisol, causing fat accumulation in the trunk and muscle wasting in the extremities.
A college student comes to the school's health clinic troubled by urinary frequency and burning with right lower back pain. Which intervention should the nurse implement first?
- A. Palpate the right flank for tenderness.
- B. Test the urine for the presence of hematuria.
- C. Evaluate the urine for a strong odor.
- D. Measure the temperature and pulse rate.
Correct Answer: D
Rationale: Measuring temperature and pulse rate is important to identify signs of systemic infection or inflammation contributing to the client's symptoms.
The nurse reviews discharge instructions with a client who has gastroesophageal reflux disease (GERD). Which instruction is most important for the nurse to emphasize?
- A. Avoid wearing tight fitting clothes.
- B. Minimize intake of spicy foods.
- C. Begin a smoking cessation program.
- D. Remain upright following meals.
Correct Answer: D
Rationale: Remaining upright following meals is essential to prevent gastric reflux by reducing pressure on the lower esophageal sphincter, minimizing reflux episodes.
History and Physical
A 59-year-old male client presents to the clinic, reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout, which he has had on 2 other occasions in the last 4 months.
The client tells the nurses that the pain started about 9 days ago in the evening and that it got very painful and swollen shortly thereafter. In the past, the gout attacks have resolved without treatment after about 5 days, but the client reports that his condition has not improved and that he is unable to walk or work
Select the 3 dietary choices that are not part of the recommended diet for a client with gout.
- A. Garlic
- B. Liver
- C. Spinach
- D. Oatmeal
- E. Chicken
- F. Shrimp
- G. Lentil
Correct Answer: B,F
Rationale: Liver and shrimp are high in purines, which can exacerbate gout by increasing uric acid levels. Garlic, oatmeal, chicken, quinoa, oranges, spinach, and lentils are generally safe or have minimal impact on gout.
The nurse is providing teaching to a client about self-management of type 2 diabetes mellitus. Which information provided by the client indicates understanding?
- A. Using salt, herbs, and spices will improve the flavor of foods.
- B. Restrict alcoholic beverages to no more than 1-2 per week.
- C. Eat a protein snack 30 minutes before any exercise workout.
- D. Get an influenza vaccine every year as soon as available.
Correct Answer: D
Rationale: Getting an influenza vaccine every year is a crucial aspect of diabetes self-management, as people with diabetes are at increased risk of complications from influenza.