Nokea
The RN is planning client assignments. Which is the least appropriate task for the nursing assistant?
- A. Assisting a COPD client admitted 2 days ago to get up in the chair
- B. Feeding a client with bronchitis who is paralyzed on the right side
- C. Accompanying a discharged emphysema client to the transportation area
- D. Assessing an emphysema client complaining of difficulty breathing
Correct Answer: D
Rationale: Assessment of breathing difficulty requires RN expertise to evaluate and intervene, making it inappropriate for a nursing assistant.
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Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis?
- A. Brushing the teeth
- B. Drinking a glass of juice
- C. Holding a cup of coffee
- D. Brushing the hair
Correct Answer: C
Rationale: Holding a warm cup of coffee can reduce morning stiffness in rheumatoid arthritis by providing warmth and gentle joint movement.
A diagnosis of multiple sclerosis is often delayed because of the varied symptoms experienced by those affected with the disease. Which symptom is most common in those with multiple sclerosis?
- A. Resting tremors
- B. Double vision
- C. Flaccid paralysis
- D. Pill-rolling tremors
Correct Answer: B
Rationale: Double vision (diplopia) is a common early symptom of multiple sclerosis due to demyelination affecting cranial nerves, particularly the optic and oculomotor nerves.
The nurse is working with a client who experiences orthostatic hypotension. Which suggestion would benefit the client?
- A. Sleep completely flat and do not use any pillows to prop your head.'
- B. Wear your support stockings when you sleep.'
- C. Take your blood pressure medicine immediately before trying to stand up.'
- D. Do not drink any liquids after 8 p.m.'
- E. None
- F. all the above
Correct Answer: E
Rationale: None of the options directly address orthostatic hypotension effectively. Support stockings during the day (not sleep), slow position changes, and adequate hydration are better strategies.
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.
A client has immune thrombocytopenic purpura. The client's platelet count is 19,000. Which initial treatment does the nurse expect?
- A. Splenectomy
- B. Immunosuppressive therapy
- C. Observation only
- D. Platelet administration
Correct Answer: B
Rationale: For ITP with a platelet count of 19,000, immunosuppressive therapy (B), like corticosteroids, is typically initial to increase platelet production. Splenectomy (A) is later, observation (C) is risky, and platelets (D) are less effective.