Nokea
When a client has their 'fight or flight' system activated, which below is a manifestation of that?
- A. Decreased blood pressure
- B. Decreased heart rate
- C. Decreased respiration rate
- D. Increased glucose levels
Correct Answer: D
Rationale: The correct answer is D, 'Increased glucose levels.' When the 'fight or flight' system is activated, the body releases glucose to provide energy for the impending response. This increase in glucose levels helps fuel the body's reaction to the perceived threat or stressor. Choices A, B, and C are incorrect because during the 'fight or flight' response, blood pressure, heart rate, and respiration rate typically increase to prepare the body to confront or flee from the perceived danger.
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What important instruction should the nurse provide regarding the application of testosterone gel in a patient with hypogonadism?
- A. Apply the gel to the chest or upper arms and allow it to dry completely before dressing.
- B. Apply the gel to the face and neck for maximum absorption.
- C. Apply the gel to the genitals for improved results.
- D. Apply the gel to the scalp and back for better results.
Correct Answer: A
Rationale: The correct instruction for applying testosterone gel in a patient with hypogonadism is to apply it to the chest or upper arms and allow it to dry completely before dressing. This method helps avoid transfer to others. Applying the gel to the face, neck, or genitals is not recommended as it can lead to unintended exposure to others. Additionally, applying the gel to the scalp and back is not a standard or effective route of administration for testosterone gel. Therefore, choice A is the correct answer as it ensures proper application and safety.
A 70-year-old man has enjoyed good overall health for all of his adult life, but he has been experiencing urinary frequency and dribbling that has culminated in a diagnosis of benign prostatic hypertrophy (BPH). As a result, the patient has been prescribed finasteride (Proscar). When teaching the patient about the potential adverse effects of the drug, the nurse should ensure that he knows about the possibility of
- A. sexual dysfunction.
- B. urethral burning.
- C. kidney stones.
- D. visual disturbances.
Correct Answer: A
Rationale: The correct potential adverse effect of finasteride (Proscar) that the nurse should educate the patient about is sexual dysfunction. Finasteride is known to cause sexual side effects such as decreased libido, erectile dysfunction, and ejaculation disorders. Urethral burning, kidney stones, and visual disturbances are not commonly associated with finasteride use, making them incorrect choices for this scenario.
A client with a history of deep vein thrombosis (DVT) is receiving anticoagulant therapy. Which complication should the nurse monitor for?
- A. Pulmonary embolism
- B. Gastrointestinal bleeding
- C. Hemorrhagic stroke
- D. Renal insufficiency
Correct Answer: A
Rationale: The correct answer is A, pulmonary embolism. In a client with a history of deep vein thrombosis (DVT) receiving anticoagulant therapy, the nurse should monitor for pulmonary embolism, as it is a serious complication. Pulmonary embolism occurs when a blood clot dislodges from the veins and travels to the lungs, potentially causing life-threatening consequences. Choices B, gastrointestinal bleeding, C, hemorrhagic stroke, and D, renal insufficiency, are not directly associated with deep vein thrombosis or anticoagulant therapy. While these complications may occur in other situations, they are not the primary concern when managing a client with a history of DVT.
What should the nurse assess in a patient experiencing breakthrough bleeding while taking oral contraceptives?
- A. Adherence to the medication schedule
- B. The possibility of pregnancy
- C. The need for an increased dosage
- D. The effectiveness of the current oral contraceptive
Correct Answer: A
Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, the nurse should assess the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of non-adherence, potentially reducing the effectiveness of the contraceptives. Assessing the adherence to the schedule helps in determining if the medication is being taken correctly. The possibility of pregnancy (choice B) is less likely if the patient has been taking the contraceptives as prescribed. Increasing the dosage (choice C) without assessing adherence first can lead to unnecessary medication adjustments. Evaluating the effectiveness of the current oral contraceptive (choice D) comes after assessing adherence to the schedule.
A tension pneumothorax requires a needle thoracostomy and/or chest tube placement as treatment to which component of the pathophysiology of the condition?
- A. An accumulation of blood in the pleural space, which makes it difficult for the lungs to exchange gases.
- B. Extreme pain caused by a fractured rib
- C. A large accumulation of trapped air in the pleural space affecting both the lungs and heart.
- D. Sudden failure of the respiratory system due to fluid accumulation in the alveoli
Correct Answer: C
Rationale: A tension pneumothorax is characterized by a large accumulation of trapped air in the pleural space, creating pressure that affects both the lungs and heart. This condition can lead to life-threatening consequences by shifting mediastinal structures and impairing cardiac function. Treatment involves decompressing the trapped air to relieve the tension. Choices A, B, and D are incorrect as they do not describe the primary pathophysiological mechanism of tension pneumothorax, which is the accumulation of air in the pleural space, not blood, rib fractures, or alveolar fluid accumulation.