Nokea
Today, the physician orders that the client's catheter can be removed. Which action is most important for the nurse to perform first?
- A. Clean the client's labia with soap and water.
- B. Measure the urine in the drainage bag.
- C. Remove the fluid from the balloon.
- D. Disconnect the client's catheter and drainage bag.
Correct Answer: C
Rationale: Deflating the balloon is essential to safely remove the catheter without causing trauma to the urethra.
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Which question is most important for the nurse to ask the client with a cystocele who is scheduled to have a pessary inserted?
- A. Do you know if you are allergic to latex?'
- B. When did you start having incontinence?'
- C. When was your last bowel movement?'
- D. Are you experiencing any pelvic pressure?'
Correct Answer: A
Rationale: Latex allergies are critical to assess before pessary insertion, as many pessaries are latex-based, risking anaphylaxis. Incontinence history, bowel movements, and pelvic pressure are relevant but secondary to safety.
After C. albicans is identified as the causative organism, the nurse would expect the physician to prescribe which treatment?
- A. A nonprescription antifungal medication
- B. A prescription oral penicillin
- C. A prescription broad-spectrum antibiotic
- D. A vaginal douche with a vinegar solution
Correct Answer: A
Rationale: Candida albicans causes yeast infections, which are typically treated with nonprescription antifungal medications like miconazole or clotrimazole.
The nurse is teaching men about early detection of prostate cancer according to the American Cancer Society (ACS) guidelines. Which should the nurse teach the clients?
- A. Beginning at age 39 a Digital Rectal Examination (DRE) followed by a prostate-specific antigen (PSA).
- B. Beginning at age 45 a rectal sonogram and, if positive, followed by a Digital Rectal Examination (DRE).
- C. Beginning at age 50 a prostate-specific antigen (PSA) followed by a Digital Rectal Examination (DRE).
- D. Beginning at age 60 a Prostate-Specific Antigen (PSA) followed, if positive, by a prostate biopsy.
Correct Answer: C
Rationale: ACS recommends PSA and DRE starting at age 50 for average-risk men. Earlier screening, sonograms, or biopsies are not standard unless indicated.
The school nurse is preparing a class on testicular cancer for male high school seniors. Which information regarding testicular self-examination should the nurse include?
- A. Perform the examination in a cool room under a fan.
- B. Any lump should be examined by an HCP as soon as possible.
- C. Discuss having a second person confirm a negative result.
- D. The procedure will cause mild discomfort if done correctly.
Correct Answer: B
Rationale: Any lump detected during testicular self-examination requires prompt HCP evaluation to rule out cancer. Cool rooms, second-person confirmation, and discomfort are not recommended.
When collecting a specimen from the client who may have gonorrhea, which nursing action is correct?
- A. Wearing latex gloves
- B. Using a disinfectant
- C. Asking the client to provide the specimen
- D. Refrigerating the specimen immediately
Correct Answer: A
Rationale: Wearing latex gloves protects the nurse from exposure to infectious material during specimen collection.