Nokea
The nurse is teaching a client with a new diagnosis of Parkinson’s disease about levodopa/carbidopa (Sinemet). Which instruction should be included?
- A. Take the medication on an empty stomach.'
- B. Expect immediate improvement in symptoms.'
- C. Avoid driving until the medication’s effects are known.'
- D. Take the medication only when tremors are severe.'
Correct Answer: C
Rationale: Levodopa/carbidopa can cause dizziness or drowsiness, so avoiding driving until effects are known ensures safety. It is best taken with food, improvement is gradual, and it is taken regularly, not as needed.
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The primary focus of nursing interventions for the child experiencing sickle cell crisis is aimed toward:
- A. Maintaining an adequate level of hydration
- B. Providing pain relief
- C. Preventing infection
- D. O2 therapy
Correct Answer: A
Rationale: Maintaining the hydration level is the focus for nursing intervention because dehydration enhances the sickling process. Both oral and parenteral fluids are used. The pain is a result of the sickling process. Analgesics or narcotics will be used for symptom relief, but the underlying cause of the pain will be resolved with hydration. Serious bacterial infections may result owing to splenic dysfunction. This is true at all times, not just during the acute period of a crisis. O2 therapy is used for symptomatic relief of the hypoxia resulting from the sickling process. Hydration is the primary intervention to alleviate the dehydration that enhances the sickling process.
A 23-year-old college student seeks medical attention at the college infirmary for complaints of severe fatigue. Her skin is pale, and she reports exertional dyspnea. She is admitted to the hospital with possible aplastic anemia. Laboratory values reflect anemia, and the client is prepared for a bone marrow biopsy. She refuses to sign the biopsy consent and states, 'Can't you just get the doctor to give me a transfusion and let me go. This weekend begins spring break, and I have plans to go to Florida.' At this time the nurse's greatest concern is that:
- A. The client may contract an infection as a result of being exposed to large crowds at spring break
- B. The client does not grasp the full impact of her illness
- C. The client may require transfusion before leaving for spring break
- D. The causative agent be identified and treatment begun
Correct Answer: B
Rationale: The client could contract an infection, but at this point it is not the most pertinent issue. The client's statement indicates that she does not grasp the full impact of her illness. Further client education must be given, along with allowing her to express her feelings regarding her illness. The client may require a transfusion, but this is a temporary measure because the causative agent has not been identified. Her feelings regarding her illness must be addressed in order for care to continue. A bone marrow is done first to make a definitive diagnosis; then treatment may begin.
While reading the progress notes on a client with cancer, the nurse notes a TNM classification of T1, N1, M0. What does this classification indicate?
- A. The tumor is in situ, no regional lymph nodes are involved, and there is no metastasis.
- B. No evidence of primary tumor exists, lymph nodes can't be assessed, and metastasis can't be assessed.
- C. The tumor is extended, with regional lymph node involvement and distant metastasis.
- D. The tumor is extended and regional lymph nodes are involved, but there is no metastasis.
Correct Answer: D
Rationale: T1 indicates a small tumor, N1 indicates regional lymph node involvement, and M0 indicates no distant metastasis. Option A is incorrect (T1 is not in situ), B is incorrect (T0, not T1, means no tumor), and C is incorrect (M0 means no metastasis).
A client in labor admits to using alcohol throughout the pregnancy. The most recent use was the day before. Based on the client's history, the nurse should give priority to assessing the newborn for:
- A. Respiratory depression
- B. Wide-set eyes
- C. Jitteriness
- D. Low-set ears
Correct Answer: C
Rationale: Fetal alcohol exposure, especially recent use, can cause neonatal withdrawal symptoms like jitteriness. Respiratory depression is less common, and physical anomalies like wide-set eyes or low-set ears are associated with chronic exposure.
The client with a recent liver transplant asks the nurse how long he will have to take an immunosuppressant. Which response is correct?
- A. One year
- B. Five years
- C. 10 years
- D. Life
Correct Answer: D
Rationale: Liver transplant recipients require lifelong immunosuppression to prevent graft rejection, as the immune system continuously recognizes the transplant as foreign.