Nokea
The nurse is talking to a client with rheumatoid arthritis who is reporting increased pain and stiffness of the joints in the morning. The nurse should encourage the client to
- A. apply a heating pad to the affected joints for a minimum of 30 minutes every morning
- B. consume a meal that is high in calories and carbohydrates every morning
- C. take a warm shower and perform range-of-motion exercises every morning
- D. take nonsteroidal anti-inflammatory medication before breakfast every morning
Correct Answer: C
Rationale: A warm shower and range-of-motion exercises (C) reduce morning stiffness and improve mobility. Heating pads (A) may help but are less comprehensive, high-calorie meals (B) are irrelevant, and NSAIDs (D) may not address stiffness immediately.
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Laboratory reference ranges
INR (Therapeutic – atrial fibrillation)
2.0-3.0
The nurse has reinforced teaching for a client with atrial fibrillation who is receiving warfarin. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.
- A. Antibiotics can affect my INR value.'
- B. I am going to eat more leafy green vegetables.'
- C. I will take the medication at the same time every day.'
- D. I understand that my INR value should be between 4 and 5.'
- E. If I miss a dose of medication, I'll double my dose the next day.'
Correct Answer: A, C
Rationale: Antibiotics affecting INR (A) and consistent timing (C) are correct. More leafy greens (B) can lower INR, INR of 4-5 (D) is too high, and doubling doses (E) is dangerous.
The spouse of a client with Alzheimer's disease expresses concern about the burden of caregiving. Which of the following actions by the nurse should be a priority?
- A. Link the caregiver with a support group
- B. Ask friends to visit regularly
- C. Schedule a home visit each week
- D. Request anti-anxiety prescriptions
Correct Answer: A
Rationale: Assisting caregivers to locate and join support groups is most helpful. Families share feelings and learn about services such as respite care. Health education is also available through local and national Alzheimer's chapters.
A client with metastatic esophageal cancer says, 'I don't want to be kept alive being fed by a tube.' What are the most appropriate ways for the nurse to ensure that this information is available to all who may need it for future decision-making? Select all that apply.
- A. Document this communication in the electronic health record
- B. Encourage the client to discuss this decision with the health care proxy
- C. Facilitate completion of an advance directive that reflects the client's decision
- D. Obtain a signed informed consent from the client
- E. Tell the health care provider (HCP) that the client needs a do-not-resuscitate (DNR) order
Correct Answer: A, B, C
Rationale: Documenting in the EHR (A), discussing with the proxy (B), and completing an advance directive (C) ensure the client's wishes are communicated. Informed consent (D) is irrelevant, and DNR (E) is not indicated.
The nurse is reinforcing teaching for a client with atrial fibrillation who has a new prescription for warfarin. Which of the following statements by the client would require follow-up?
- A. I will avoid taking over-the-counter aspirin.'
- B. I must avoid consuming green, leafy vegetables such as spinach and kale.'
- C. I should avoid consuming any caffeinated products.'
- D. I will talk with my health care provider before taking any nutritional supplements.'
Correct Answer: B
Rationale: Avoiding all green leafy vegetables (B) is incorrect; consistent intake is needed to maintain stable INR. Avoiding aspirin (A), caffeine (C), and consulting about supplements (D) are correct.
An adult is scheduled for a total laryngectomy. When preparing the client for surgery, it is essential for the nurse to take which of the following actions?
- A. Teach the client esophageal speech
- B. Teach the client how to lip read
- C. Assess the client's ability to read and write
- D. Determine the client's usual means of dealing with a sore throat
Correct Answer: C
Rationale: A laryngectomy removes the voice box, requiring alternative communication; assessing literacy ensures post-op communication via writing, critical for care planning.