Nokea
Which intervention promotes comfort post-cystectomy?
- A. Encourage deep breathing.
- B. Restrict all fluids.
- C. Keep in supine position.
- D. Administer IV antibiotics.
Correct Answer: A
Rationale: Deep breathing prevents respiratory complications and promotes comfort.
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The client's wife asks the nurse whether the I.V. infusion is meeting her husband's nutritional needs because he has vomited several times. The nurse's response should be based on the knowledge that 1 L of 5% dextrose in normal saline solution delivers:
- A. 170 calories.
- B. 250 calories.
- C. 340 calories.
- D. 500 calories.
Correct Answer: A
Rationale: One liter of 5% dextrose provides 50 g of dextrose, yielding approximately 170 calories, insufficient for full nutritional needs.
A client has an emergency embolectomy for an embolus in the femoral artery. After the client returns from the recovery room, in what order, from first to last, should the nurse provide care?
- A. Administer pain medication
- B. Draw blood for laboratory studies
- C. Regulate the I.V. infusion
- D. Monitor the pulses
- E. Inspect the dressing
Correct Answer: D,C,A,B,E
Rationale: Order: 1) Monitor pulses (ensure arterial patency post-embolectomy); 2) Regulate I.V. infusion (maintain hydration/perfusion); 3) Administer pain medication (manage comfort); 4) Draw blood for labs (monitor coagulation); 5) Inspect dressing (check for bleeding/infection).
A client in a hospice program has increasing pain. The nurse and client collaborate to schedule analgesics to provide which of the following?
- A. Doses of analgesic when pain is a '5' on a scale of 1-10.
- B. Enough analgesia to keep the client semisomnolent.
- C. An analgesia-free period so that the client can carry out daily hygienic activities.
- D. Around-the-clock routine administration of analgesics for continuous pain relief.
Correct Answer: D
Rationale: Around-the-clock administration of analgesics ensures continuous pain relief, which is critical for hospice patients with persistent pain, preventing pain escalation.
Which of the following signs and symptoms are common in male clients with prolactin-secreting tumors?
- A. Severe lethargy and fatigue.
- B. Erectile dysfunction and decreased libido.
- C. Both of the above
- D. None of the above
Correct Answer: B
Rationale: Prolactin-secreting tumors in males often cause erectile dysfunction and decreased libido due to suppression of testosterone.
A 10-year-old client is diagnosed with infectious mononucleosis. Her white blood cell (WBC) count is 19,000/µL. She has a streptococcal throat infection and her spleen is enlarged. She has aching muscles. Which of the following instructions should the nurse include in discharge planning with the client and the essential caregiver? Select all that apply.
- A. Stay on bed rest until the temperature is normal.
- B. Gargle with warm saline while the throat is irritated.
- C. Increase intake of fluids until the infection subsides.
- D. Take aspirin as long as the fever and myalgia persist.
- E. Avoid contact sports while the spleen is enlarged.
Correct Answer: B,C,E
Rationale: Infectious mononucleosis with an enlarged spleen requires avoiding contact sports to prevent splenic rupture, a serious complication. Gargling with warm saline soothes the throat, and increased fluids support recovery and prevent dehydration. Bed rest is not strictly necessary unless fever persists, and aspirin should be avoided in children due to the risk of Reye's syndrome.