Nokea
The nurse is seeing a client in the clinic who has shingles (herpes zoster). The client is concerned about spreading the disease to others. How should the nurse respond?
- A. It is only possible to have one episode of the disease.
- B. Persons with leukemia are at higher risk.
- C. Persons of all ages should receive the zoster vaccine (Zostavax).
- D. Persons between 30 and 40 years old are at high risk.
Correct Answer: B
Rationale: Shingles is contagious to immunocompromised individuals, such as those with leukemia, via contact with active lesions. The vaccine is recommended for older adults, not all ages, and recurrence is possible.
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A client is scheduled for knee replacement surgery, and the nurse is reviewing preoperative laboratory results. The nurse should notify the physician about which of the following abnormal laboratory results?
- A. Platelets 119,000.
- B. Glucose 83.
- C. Hemoglobin 13.7.
- D. Sodium 141.
Correct Answer: A
Rationale: A platelet count of 119,000 (A) is below the normal range (150,000-450,000), increasing bleeding risk during surgery, and should be reported. Glucose 83 (B), hemoglobin 13.7 (C), and sodium 141 (D) are within normal limits.
A client with acute leukemia develops a low white blood cell count. In addition to the institution of isolation, the nurse should:
- A. Request that foods be served with disposable utensils
- B. Ask the client to wear a mask when visitors are present
- C. Prep IV sites with mild soap and water and alcohol
- D. Provide foods in sealed, single-serving packages
Correct Answer: D
Rationale: Sealed, single-serving foods reduce infection risk in neutropenic patients.
The nurse is working in the emergency room when a client arrives with severe burns of the left arm, hands, face, and neck. Which action should receive priority?
- A. Starting an IV
- B. Applying oxygen
- C. Obtaining blood gases
- D. Medicating the client for pain
Correct Answer: B
Rationale: Applying oxygen is the priority to ensure airway patency and oxygenation in a client with facial and neck burns, which can cause airway compromise.
Which of the following roommates would be most suitable for the client with myasthenia gravis?
- A. A client with hypothyroidism
- B. A client with Crohn's disease
- C. A client with pylonephritis
- D. A client with bronchitis
Correct Answer: A
Rationale: Hypothyroidism poses no infection risk, unlike pyelonephritis or bronchitis.
A client with liver failure and ascites is having a paracentesis to relieve severe dyspnea resulting from abdominal fluid accumulation. Prior to the procedure, the nurse assists the client to urinate. Which of the following is the most important reason to have the patient urinate?
- A. Patient comfort
- B. Prevention of incontinence
- C. Prevention of bladder puncture
- D. Fluid displacement
Correct Answer: C
Rationale: Urinating before paracentesis prevents bladder puncture (C) by emptying the bladder, reducing risk during needle insertion.