Nokea
The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The nurse should:
- A. Tell the client to avoid a tub bath for 48 hours
- B. Tell the client to expect clay-colored stools
- C. Tell the client that she can expect lower abdominal pain for the next week
- D. Tell the client to report pain in the back or shoulders
Correct Answer: D
Rationale: Pain in the back or shoulders post-laparoscopic cholecystectomy may indicate referred pain from residual CO2 or complications, requiring prompt reporting.
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Which of the following observations best indicates to the nurse that a paraplegic client can adequately carry out activities of daily living at home after discharge?
- A. The client can shave himself and brush his teeth.
- B. The client can transfer himself into and out of his wheelchair.
- C. The client can maneuver his wheelchair without difficulty.
- D. The client can prepare his own well-balanced meals.
Correct Answer: B
Rationale: essential if client is to perform ADLs
A vaginal exam reveals a footling breech presentation. The nurse should take which of the following actions at this time?
- A. Anticipate the need for a Caesarean section
- B. Apply an internal fetal monitor
- C. Place the client in Genu Pectoral position
- D. Perform an ultrasound
Correct Answer: A
Rationale: Footling breech presentation often requires a Caesarean section due to risks of cord prolapse and delivery complications.
The nurse is caring for a client who is 14 weeks pregnant. The client is asking about vaccinations that can be given during pregnancy. Which of the following vaccines does the nurse tell the client that are safe during pregnancy?
- A. mumps
- B. measles
- C. smallpox
- D. influenza
Correct Answer: D
Rationale: The influenza vaccine is safe and recommended during pregnancy. Mumps, measles, and smallpox vaccines are contraindicated.
A dexamethasone-suppression test has been ordered for a client with severe depression. The purpose of the dexamethasone suppression test is to:
- A. Determine which social intervention will be best for the client
- B. Help diagnose the seriousness of the client's clinical symptoms
- C. Determine whether the client will benefit from electroconvulsive therapy
- D. Reverse the depressive symptoms the client is experiencing
Correct Answer: B
Rationale: The dexamethasone suppression test assesses cortisol suppression to evaluate hypothalamic-pituitary-adrenal axis dysfunction, aiding in diagnosing severe depression.
All of the following are parts of the middle ear EXCEPT the
- A. pinna.
- B. incus.
- C. stapes.
- D. malleus.
Correct Answer: A
Rationale: The middle ear includes the incus, stapes, and malleus (ossicles). The pinna is part of the outer ear.