Nokea
Which comment is the client who has Parkinson's disease most likely to make?
- A. My hands shake when I reach to pick up my coffee cup.'
- B. I get very stiff when I sit for long periods of time.'
- C. I have to drink a lot because my mouth is so dry.'
- D. It is easier for me to pick up my feet than to slide them.'
Correct Answer: B
Rationale: Rigidity and stiffness, especially after immobility, are hallmark Parkinson's symptoms, unlike tremors (more action-specific), dry mouth, or gait preferences.
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A client has been taking propranolol (Inderal) 40 mg bid and furosemide (Lasix) 40 mg qd for several months. Two weeks ago, the physician added verapamil (Calan) 80 mg tid to his medication regimen.
It is MOST important for the nurse to assess for which of the following?
- A. Tachycardia.
- B. Diarrhea.
- C. Peripheral edema.
- D. Impotence.
Correct Answer: C
Rationale: Strategy: Determine how each answer choice relates to medication. (1) will cause bradycardia (2) usually causes constipation (3) correct-Calan is a calcium-channel blocker, depresses myocardial contractility, decreases work of ventricles and O2 demand, dilates coronary arteries, when used with other antihypertensives can cause hypotension and heart failure (4) not most important or frequent side effect
The nurse is conducting a community group discussion on nutrition. One of the participants says to the nurse, 'I am a vegan. I have been told I might get pernicious anemia. How can I prevent that?' What should the nurse include when answering the client?
- A. She is not at risk for pernicious anemia because there are many nonmeat sources of vitamin B12.
- B. She is at risk of developing pernicious anemia, but taking a vitamin supplement that contains vitamin B12 should prevent it.
- C. She should see her physician and ask about getting monthly injections of vitamin B12 because she is a risk for pernicious anemia.
- D. She should be tested for an enzyme that produces vitamin B12. If she is deficient, she should be treated with daily injections.
Correct Answer: B
Rationale: Vegans lack dietary B12 (found in animal products), risking pernicious anemia. Oral B12 supplements can prevent deficiency, while injections or enzyme testing are unnecessary unless absorption issues exist.
The nurse is bathing a client who has contact isolation ordered. The nurse wears gloves. What else is needed?
- A. Face mask
- B. Sterile gloves
- C. Isolation cap
- D. Isolation gown
Correct Answer: D
Rationale: An isolation gown prevents contact transmission, required alongside gloves for bathing a client in contact isolation.
The nurse observes a staff member caring for a client with a left unilateral mastectomy. The nurse would intervene if she notices the staff member is
- A. Advising client to restrict sodium intake
- B. Taking the blood pressure in the left arm
- C. Elevating her left arm above heart level
- D. Compressing the drainage device
Correct Answer: B
Rationale: Taking the blood pressure in the left arm. Clients who have had a unilateral mastectomy should not have their blood pressure measured on the affected side. This helps avoid the possibility of lymphedema post-operatively and in the future.
A client with end-stage renal failure is to receive a kidney transplant from her sister. Prior to surgery, the client will be scheduled for:
- A. An intravenous pyelogram
- B. Hemodialysis
- C. A voiding cystogram
- D. A renal biopsy
Correct Answer: B
Rationale: Hemodialysis is typically performed before a kidney transplant to optimize the client's electrolyte and fluid balance, ensuring a stable condition for surgery.