Which diet would the nurse expect to see ordered for a patient with nephrotic syndrome?
- A. Low carbohydrate potassium
- B. Moderate protein
- C. Low calcium
- D. Increased potassium
Correct Answer: B
Rationale: Nephrotic syndrome causes proteinuria, leading to hypoalbuminemia. A moderate protein diet (0.8–1 g/kg/day) helps replace lost protein without overloading the kidneys. Low carbohydrate, low calcium, or increased potassium diets are not specific to nephrotic syndrome.
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The nurse is caring for a client with a history of heart failure. Which discharge instruction is most important?
- A. Weigh yourself daily.'
- B. Limit exercise to 10 minutes daily.'
- C. Increase sodium intake.'
- D. Take over-the-counter pain relievers as needed.'
Correct Answer: A
Rationale: Daily weight monitoring detects fluid retention early in heart failure, allowing timely intervention. Exercise should be moderate, sodium restricted, and pain relievers used cautiously.
The client is receiving a continuous heparin infusion. Which laboratory value should the nurse monitor most closely?
- A. Platelet count
- B. Prothrombin time (PT)
- C. Activated partial thromboplastin time (aPTT)
- D. International normalized ratio (INR)
Correct Answer: C
Rationale: Heparin’s anticoagulant effect is monitored by aPTT, with a therapeutic range of 1.5–2.5 times the control value. Platelet count is monitored for heparin-induced thrombocytopenia, but PT and INR are for warfarin.
A client is experiencing muscle weakness and lethargy. His serum K+ is 3.2. What other symptoms might he exhibit?
- A. Tetany
- B. Dysrhythmias
- C. Numbness of extremities
- D. Headache
Correct Answer: B
Rationale: Low potassium (3.2) causes dysrhythmias due to its role in cardiac muscle activity. The other symptoms are not associated with hypokalemia.
Which person is at greatest risk for developing Lyme disease?
- A. Computer programmer
- B. Elementary teacher
- C. Veterinarian
- D. Landscaper
Correct Answer: D
Rationale: Landscapers are at higher risk for Lyme disease due to frequent outdoor exposure in areas where ticks, which transmit the disease, are prevalent.
In planning daily care for a client with multiple sclerosis, the nurse would take into consideration that multiple sclerosis:
- A. Becomes progressively debilitating without remission
- B. Has unpredictable remissions and exacerbations
- C. Is rapidly fatal
- D. Responds quickly to antimicrobial therapy
Correct Answer: B
Rationale: Multiple sclerosis eventually becomes debilitating, but it is characterized by remission of symptoms. Remissions and exacerbations are unpredictable with multiple sclerosis. The client experiences progressive dysfunction after each exacerbation episode. Multiple sclerosis is usually slowly progressive. Multiple sclerosis is an autoimmune disease. Antimicrobial therapy has no effect on its course.
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