Nokea
Which intervention should the nurse implement to help toughen the residual limb of a client with a right AKA?
- A. Push residual limb against pillow
- B. Apply elastic bandage around residual limb
- C. Apply vitamin B12 to surgical incision
- D. Elevate residual limb three times a day
Correct Answer: B
Rationale: Elastic bandages shape and toughen the residual limb, preparing it for prosthesis.
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The 65-year-old client is diagnosed with macular degeneration. Which statement by the client indicates the client needs more discharge teaching?
- A. I should use magnification devices as much as possible.
- B. I will look at my Amsler grid at least twice a week.
- C. I need to use low-watt light bulbs in my house.
- D. I am going to contact a low-vision center to evaluate my home.
Correct Answer: C
Rationale: Low-watt bulbs reduce visibility; macular degeneration patients need bright light to compensate for central vision loss, indicating a need for more teaching.
A client has been experiencing anovulatory dysfunctional uterine bleeding. The client is 25 years of age, and is concerned about maintaining her fertility. Based upon your knowledge, which management technique likely would be employed first?
- A. Oral contraceptives
- B. Progestin therapy
- C. Therapeutic D and C
- D. Endometrial ablation
Correct Answer: A
Rationale: Oral contraceptives regulate anovulatory bleeding while preserving fertility, making them the first-line treatment for this client.
A patient with an exceptionally low body mass index has been admitted to the emergency department with signs and symptoms of hypothermia. The nurse should know that this patients susceptibility to heat loss is related to atrophy of what skin component?
- A. Epidermis
- B. Merkel cells
- C. Dermis
- D. Subcutaneous tissue
Correct Answer: D
Rationale: The subcutaneous tissues and the amount of fat deposits are important factors in body temperature regulation.
The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which finding should alert the nurse to the presence of a possible postoperative complication?
- A. Anxiety
- B. Leukocytosis
- C. Chvostek's sign
- D. Urinary output of 800 mL/hour
Correct Answer: D
Rationale: Urinary output of 800 mL/hour suggests diabetes insipidus, a common complication post-hypophysectomy due to pituitary damage, unlike the other findings which are less specific.
Which symptom is consistent with an inhalation burn?
- A. Full-thickness burns to chest
- B. Hypotension
- C. Agitation
- D. Persistent coughing
Correct Answer: D
Rationale: Persistent coughing, particularly if black mucus is coughed up, is an indicator of an inhalation burn.