Nokea
The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which one of the following results indicates the presence of inflammation?
- A. Decreased sedimentation rate
- B. Thrombocytopenia
- C. Leukocytosis
- D. Erythrocytosis
Correct Answer: C
Rationale: Leukocytosis, an elevated white blood cell count, indicates inflammation or infection. Decreased sedimentation rate, thrombocytopenia, and erythrocytosis are not specific to inflammation.
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A client with diabetes is explaining to the nurse how she will care for her feet at home. Which statement indicates that the client understands proper foot care?
- A. When I injure my toe, I will plan to put iodine on it.'
- B. I should inspect my feet at least once a week.'
- C. It is okay to go barefoot in the house.'
- D. It is important to dry my feet carefully after my bath.'
Correct Answer: D
Rationale: Thorough drying prevents moisture-related infections, critical for diabetic foot care to avoid complications like ulcers.
The nurse is assessing a client with suspected pulmonary edema. Which finding supports this diagnosis?
- A. Crackles in lung bases
- B. Dry cough
- C. Clear lung sounds
- D. Bradycardia
Correct Answer: A
Rationale: Crackles in the lung bases indicate fluid accumulation in the alveoli, a key sign of pulmonary edema requiring urgent intervention.
The nurse is assessing a neonate at 5 minutes after birth. The nurse records the Apgar score based on the findings in the chart below. The nurse compares these findings to the Apgar score obtained at birth, as determined by the findings in the chart below. What should the nurse do next?
- A. Notify the neonatologist on call.
- B. Continue to assess the neonate.
- C. Apply an oxygen mask.
- D. Rub the neonate's extremities.
Correct Answer: B
Rationale: Without specific Apgar score data, the standard action is to continue assessing the neonate, as Apgar scores at 5 minutes guide ongoing monitoring unless critical findings are present.
A client with a history of schizophrenia is prescribed olanzapine (Zyprexa). The nurse should monitor the client for which of the following adverse effects?
- A. Weight gain.
- B. Hypoglycemia.
- C. Bradycardia.
- D. Hypotension.
Correct Answer: A
Rationale: Olanzapine commonly causes weight gain, requiring monitoring.
A client has begun medication therapy with pancrelipase. The nurse should educate the client to expect which occurrence from this medication?
- A. Relieve of heartburn
- B. Eliminate of abdominal pain
- C. Help regulating blood glucose
- D. Decrease in the amount of fat in the stools
Correct Answer: D
Rationale: Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. It does not regulate blood glucose; this is a function of insulin, a hormone produced in the beta cells of the pancreas.