Nokea
The physician has ordered a culture for the client with suspected gonorrhea. The nurse should obtain a culture of:
- A. Blood
- B. Nasopharyngeal secretions
- C. Stool
- D. Genital secretions
Correct Answer: D
Rationale: Gonorrhea is diagnosed by culturing genital secretions.
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The nurse is caring for a client receiving Capoten (captopril). The nurse should be alert for adverse reactions to the drug, which include:
- A. Increased red cell count
- B. Decreased sodium level
- C. Decreased white cell count
- D. Increased calcium level
Correct Answer: C
Rationale: Captopril, an ACE inhibitor, can cause agranulocytosis, leading to a decreased white cell count, which should be monitored.
After several hospitalizations for respiratory ailments, a 6-month-old has been diagnosed as having HIV. The infant's respiratory ailments were most likely due to:
- A. Pneumocystis carinii
- B. Cytomegalovirus
- C. Cryptosporidiosis
- D. Herpes simplex
Correct Answer: A
Rationale: Pneumocystis carinii (now Pneumocystis jirovecii) is a common cause of pneumonia in HIV-infected infants.
The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
- A. I will make sure I eat breakfast within 10 minutes of taking my insulin.
- B. I will need to carry candy or some form of sugar with me all the time.
- C. I will eat a snack around three o'clock each afternoon.
- D. I can save my dessert from supper for a bedtime snack.
Correct Answer: C
Rationale: Novolog insulin peaks around 1-3 hours after administration, so a snack around 3 PM aligns with the peak to prevent hypoglycemia.
The nurse is caring for a client with cancer who is exhibiting signs and symptoms that death is near. The client's daughter says that she does not want her mother to receive morphine because it will hasten her death. What response by the nurse is most appropriate?
- A. We always give morphine to clients at the end-of-life stage.
- B. We can give oxygen instead of morphine to help with breathing and distress.
- C. Morphine will reduce anxiety and reduce the sensation of air hunger in your mother.
- D. We will wait until the very end to give the morphine and use nonpharmacologic measures instead.
Correct Answer: C
Rationale: Morphine alleviates air hunger and anxiety in end-of-life care, improving comfort without necessarily hastening death, addressing the daughter’s concerns therapeutically.
A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:
- A. Is the opening on the client's left side
- B. Is the opening on the distal end on the client's left side
- C. Is the opening on the client's right side
- D. Is the opening on the distal right side
Correct Answer: C
Rationale: The proximal end of a double-barrel colostomy, which produces stool, is typically on the client's right side.