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The nurse should teach the client with Addison's disease that the adverse effect of bronze-colored skin is thought to be caused by which of the following?
- A. Hypersensitivity to sun exposure.
- B. Increased serum bilirubin level.
- C. Adverse effects of the glucocorticoid therapy.
- D. Increased secretion of adrenocorticotropic hormone (ACTH).
Correct Answer: D
Rationale: Bronze-colored skin in Addison's disease results from increased ACTH, which stimulates melanin production.
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The nurse teaches the client with chronic cancer pain about optimal pain control. Which of the following recommendations is most effective for pain control?
- A. Get used to some pain and use a little less medication than needed to keep from being addicted.
- B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain.
- C. Take analgesics only when pain returns.
- D. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain.
Correct Answer: B
Rationale: Taking analgesics around-the-clock prevents recurrent pain by maintaining steady drug levels, which is the most effective strategy for chronic cancer pain.
The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack?
- A. Occupational exposure to toxins.
- B. Viral respiratory infections.
- C. Exposure to cigarette smoke.
- D. Exercising in cold temperatures.
Correct Answer: B
Rationale: Viral respiratory infections are a leading trigger of acute asthma attacks due to airway inflammation. Toxins, smoke, and cold exercise are also triggers but less common.
A nurse is participating in a diabetes screening program. Who of the following is (are) at risk for developing type 2 diabetes? Select all that apply.
- A. A 32-year-old female who delivered a 9½-lb infant.
- B. A 44-year-old Native American Indian who has a body mass index (BMI) of 32.
- C. An 18-year-old Hispanic who jogs four times a week.
- D. A 55-year-old Asian American who has hypertension and two siblings with type 2 diabetes.
- E. A 12-year-old who is overweight.
Correct Answer: A,B,D,E
Rationale: Risk factors for type 2 diabetes include history of delivering a large infant, obesity (BMI >30), family history, hypertension, and being overweight, especially in youth. Regular exercise reduces risk, making the 18-year-old less likely to be at risk.
The client who does not respond adequately to fluid replacement has an order for an I.V. infusion of dopamine hydrochloride at 5 µg/kg/minute. To determine that the drug is having the desired effect, the nurse should assess the client for:
- A. Increased renal and mesenteric blood flow.
- B. Increased cardiac output.
- C. Vasoconstriction.
- D. Reduced preload and afterload.
Correct Answer: B
Rationale: Dopamine at 5 µg/kg/minute primarily increases cardiac output by enhancing myocardial contractility and heart rate, improving perfusion in shock. Renal/mesenteric flow occurs at lower doses, vasoconstriction at higher doses, and preload/afterload reduction is not a primary effect.
A client scheduled for a cholecystectomy expresses fear about postoperative pain. Which nursing action is most appropriate?
- A. Administer preoperative analgesics as ordered.
- B. Teach the client about pain management options.
- C. Reassure the client that pain is minimal after surgery.
- D. Refer the client to a pain management specialist.
Correct Answer: B
Rationale: Teaching the client about pain management options, such as PCA or oral analgesics, empowers them to understand and cope with postoperative pain, reducing anxiety. Administering analgesics may not be ordered preoperatively, and reassurance without education is inadequate.