Nokea
What should the nurse teach a client who is recommended antianxiety drugs?
- A. Use the drug on a long-term basis
- B. Avoid lifting heavy weights
- C. Use caution when driving
- D. Be aware that the drug causes excessive sleeplessness
Correct Answer: C
Rationale: Antianxiety drugs can impair motor skills, so clients should avoid driving or operating machinery until they know how the medication affects them.
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The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing?
- A. Witnessing the patient's signature
- B. Obtaining informed consent from the patient for the surgery
- C. Verifying that the consent for surgery is truly voluntary and informed
- D. Ensuring that the patient is mentally competent to sign the consent form
Correct Answer: A
Rationale: The nurse acts as a witness to the patient's signature on the consent form, verifying that it was signed voluntarily.
During an ophthalmic assessment, which of the following is the nurse expected to observe carefully?
- A. Level of central vision
- B. Internal eye condition
- C. Pupil responses
- D. Rate of blinking
Correct Answer: C
Rationale: Pupil responses are critical in assessing neurological and ocular health. They provide important clues about potential disorders.
Which finding on assessment supports the nursing diagnosis Decreased Cardiac Output related to decreased plasma volume?
- A. Flattened neck veins when client is in supine position
- B. Full and bounding pedal and post-tibial pulses
- C. Pitting edema located in feet ankles and calves
- D. Shallow respirations with crackles on auscultation
Correct Answer: A
Rationale: Flattened neck veins in the supine position indicate reduced venous return due to decreased plasma volume, which supports the diagnosis of Decreased Cardiac Output.
A postoperative priority nursing diagnosis for a client having a vertical partial laryngectomy would be:
- A. activity intolerance.
- B. ineffective airway clearance.
- C. high-risk for infection.
- D. an altered oral mucous membrane.
Correct Answer: B
Rationale: The laryngectomy client should be able to gradually increase activities without difficulty. The laryngectomy client may have copious amounts of secretions, which will require suctioning for the first 24-48 hours. Because the mucous collects in the cannula, it will require cleaning after the first 24 hours. Even though the client does have a potential for infection, this is not more important than the ineffective airway clearance. An altered mucous membrane problem is not more important than ineffective airway clearance. The client's mouth may become dry, but can be taken care of with good oral care.
When assigning staff to patients who are receiving chemotherapy, what is the major consideration about chemotherapeutic drugs?
- A. During preparation,drugs may be absorbed through the skin or inhaled.
- B. Many chemotherapeutics are vesicants.
- C. Chemotherapeutics are frequently given through central venous access devices.
- D. Oral and venous routes are the most common.
Correct Answer: A
Rationale: Safety precautions during drug preparation are paramount due to the potential for hazardous exposure to healthcare workers.