Nokea
The nurse is developing a discharge plan about home care with a client who has lymphoma. The nurse should emphasize which of the following?
- A. Use analgesics as needed.
- B. Take a shower with perfumed shower gel.
- C. Wear a mask when outside of the home.
- D. Take an antipyretic every morning.
Correct Answer: A
Rationale: Clients with lymphoma may experience pain from lymph node enlargement or treatment. Using analgesics as needed is appropriate for symptom management. Perfumed shower gel may irritate skin, masks are not routinely needed, and daily antipyretics are unnecessary unless fever persists.
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What is a goal of care for a client with acute renal failure?
- A. Maintain urine output of 30 mL/hour.
- B. Keep potassium above 5.5 mEq/L.
- C. Increase protein intake.
- D. Limit ambulation.
Correct Answer: A
Rationale: Maintaining adequate urine output indicates improving renal function.
The nurse is providing discharge teaching for a client post-inguinal herniorrhaphy. Which statement by the client indicates a need for further teaching?
- A. I'll avoid heavy lifting for about 6 weeks.
- B. I can take a shower tomorrow.
- C. I'll call the doctor if I have a fever.
- D. I can resume sexual activity next week.
Correct Answer: D
Rationale: Resuming sexual activity within a week post-inguinal herniorrhaphy may strain the surgical site, indicating a need for further teaching to delay such activities for 4–6 weeks. The other statements align with appropriate postoperative care. CN: Health promotion and maintenance; CL: Evaluate
When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift the patient.
- A. While inhaling through an open mouth.
- B. While exhaling through pursed lips.
- C. After exhaling but before inhaling.
- D. While taking a deep breath and holding it.
Correct Answer: B
Rationale: Lifting while exhaling through pursed lips conserves energy by aligning effort with prolonged exhalation, reducing air trapping in COPD. Other methods increase respiratory workload.
The nurse is conducting a focused assess of the gastrointestinal system of a client with a burn injury. The nurse should assess the client for:
- A. Paralytic ileus.
- B. Gastric distention.
- C. Hiatal hernia.
- D. Curling's ulcer.
Correct Answer: D
Rationale: Burn injuries increase stress and metabolic demand, predisposing clients to Curling's ulcer, a stress-related gastric ulcer, due to reduced mucosal protection.
What is the nurse's best action for a client with a migraine headache?
- A. Administer oxygen.
- B. Provide a quiet, dark environment.
- C. Encourage fluid restriction.
- D. Apply a warm compress.
Correct Answer: B
Rationale: A quiet, dark environment reduces stimuli that exacerbate migraine symptoms.