What should be included in the care plan of a client who has myxedema?
- A. Encourage frequent rest periods
- B. Have the client do deep breathing and coughing exercises frequently
- C. Provide a cool environment
- D. Offer frequent high-calorie snacks
Correct Answer: A
Rationale: Myxedema (severe hypothyroidism) causes fatigue; frequent rest periods conserve energy. Deep breathing, cool environments, or high-calorie snacks are not prioritized.
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A client is receiving scheduled doses of carbidopa-levodopa. The nurse evaluates the medication as having the intended effect if which finding is noted?
- A. Improvement in short-term memory
- B. Improvement in spontaneous activity
- C. Reduction in number of visual hallucinations
- D. Reduction of dizziness with standing
Correct Answer: B
Rationale: Carbidopa-levodopa treats Parkinson's symptoms like bradykinesia, improving spontaneous activity, which is the primary therapeutic goal.
The nurse in a long-term care facility observes a nursing assistant caring for a resident who has a hearing aid and dentures. Which action by the nursing assistant should be corrected?
- A. The nursing assistant places a washcloth in the sink before brushing the client's dentures.
- B. The nursing assistant uses toothpaste to clean the dentures.
- C. The nursing assistant uses alcohol to wipe off the exterior of the hearing aid.
- D. The nursing assistant wipes the exterior of the hearing aid with a damp cloth.
Correct Answer: C
Rationale: The exterior of a hearing aid should be wiped regularly with a damp cloth. Alcohol should not be used as it can damage the device. The nursing assistant should place a washcloth in the sink before brushing dentures to protect them if dropped. Toothpaste is appropriate to clean dentures.
The nurse has reinforced teaching for a client with newly diagnosed von Willebrand disease. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.
- A. I can use a humidifier to help prevent nosebleeds.
- B. I need to wear gloves while doing yard work.
- C. I should use a soft-bristled toothbrush and floss carefully.
- D. I will notify my health care provider if I soak a menstrual pad in an hour.
- E. I will take NAPROXEN to decrease pain and inflammation if I am injured.
Correct Answer: A,C,D
Rationale: Using a humidifier (A) prevents mucosal drying and nosebleeds. A soft-bristled toothbrush and careful flossing (C) minimize gum bleeding. Reporting heavy menstrual bleeding (D) is critical to manage bleeding risks in von Willebrand disease.
During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:
- A. Syphilis
- B. Herpes
- C. Gonorrhea
- D. Condylomata
Correct Answer: B
Rationale: A lesion that is painful is most likely a herpetic lesion. A chancre lesion associated with syphilis is not painful, so answer A is incorrect. Gonorrhea does not present as a lesion but is exhibited by a yellow discharge, so answer C is incorrect. Condylomata lesions are painless warts, so answer D is incorrect.
The nurse is caring for an older client who had a cerebrovascular accident (CVA) several days ago. She is having trouble speaking. How should the nurse relate to this client?
- A. Encourage the client to speak and wait patiently while she tries
- B. Speak louder to the client
- C. Finish the client's sentences when she is having difficulty
- D. Tell the client to rest her voice for the next few days
Correct Answer: A
Rationale: Encouraging speech with patience supports recovery in aphasia post-CVA, unlike loud speech, finishing sentences, or voice rest, which hinder communication progress.
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