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Which information should the nurse include in the discharge teaching for the client recovering from an abdominal hysterectomy?
- A. The client should report any vaginal bleeding or cramping to the surgeon.
- B. The client should start a vigorous exercise routine to restore her muscle tone.
- C. The client should continue sitting in the bedside chair at least six (6) hours daily.
- D. The client should soak in a warm tub bath each night for one (1) hour.
Correct Answer: A
Rationale: Reporting vaginal bleeding or cramping is critical, as these may indicate complications like hemorrhage or infection. Vigorous exercise is contraindicated, prolonged sitting is unnecessary, and tub baths risk infection.
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Which nursing interventions are most appropriate to add to the client's immediate postoperative care plan? Select all that apply.
- A. Elevate the affected arm to reduce swelling.
- B. Monitor for signs of infection at the surgical site.
- C. Encourage early ambulation to prevent complications.
- D. Administer prescribed pain medications as needed.
- E. Teach the client to avoid using the affected arm for 6 weeks.
Correct Answer: A,B,C,D
Rationale: Elevating the arm reduces lymphedema risk, monitoring for infection ensures early detection, ambulation prevents complications like thrombosis, and pain management promotes comfort. Restricting arm use for 6 weeks is excessive and not standard.
What special instruction concerning the technique for taking vital signs is most important when assigning this task to a nursing assistant?
- A. Count the client's respirations while he is resting.
- B. Assess the client's pulse at the radial site.
- C. Take the client's blood pressure with an electronic machine.
- D. Avoid taking a rectal temperature.
Correct Answer: D
Rationale: Avoiding rectal temperature measurement prevents trauma or infection in a client with a suprapubic prostatectomy and catheters.
The outpatient clinic nurse is working with clients diagnosed with sexually transmitted diseases (STD). Which long-term complication should the nurse discuss with the clients about STDs?
- A. Stress the need for clients to completely finish all antibiotics prescriptions.
- B. Inform the clients that, legally, many STIs must be reported to the health department.
- C. Sexually transmitted diseases can result in reproductive problems.
- D. Discuss the myth that acquired immunodeficiency syndrome is an STI.
Correct Answer: C
Rationale: STDs like chlamydia and gonorrhea can cause infertility or ectopic pregnancy, a critical long-term complication. Antibiotic completion, reporting, and AIDS myths are important but not complications.
The client has a diagnosis of rule-out Paget’s disease. Which test provides a definitive diagnosis of the disease?
- A. A breast biopsy.
- B. A diagnostic mammogram.
- C. Ultrasound of the breast.
- D. Magnetic resonance imaging.
Correct Answer: A
Rationale: Breast biopsy provides a definitive diagnosis for Paget’s disease by confirming malignant cells in the nipple/areola. Mammogram, ultrasound, and MRI are supportive but not confirmatory.
The nurse is working in a health clinic. Which disease is required to be reported to the public health department?
- A. Pelvic inflammatory disease.
- B. Epididymitis.
- C. Syphilis.
- D. Ectopic pregnancy.
Correct Answer: C
Rationale: Syphilis is a reportable STD to track and control spread, per public health regulations. PID, epididymitis, and ectopic pregnancy are not typically reportable.