Nokea
Which of the following clients is at greatest risk for Buerger's disease?
- A. A 29-year-old male with a 14-year history of cigarette smoking
- B. A 38-year-old female who is taking birth control pills
- C. A 54-year-old female with adult onset diabetes
- D. A 65-year-old male with atherosclerosis
Correct Answer: A
Rationale: Buerger's disease (thromboangiitis obliterans) is strongly associated with heavy tobacco use, particularly in young males. A 29-year-old male with a 14-year smoking history is at greatest risk. Birth control pills, diabetes, and atherosclerosis are not primary risk factors for Buerger's disease.
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The right hand of a client with multiple sclerosis trembles severely whenever she attempts a purposeful act, such as picking up her coffee cup or buttoning her dress. Which is the best legal documentation in nurses' notes of the chart for this client assessment?
- A. "Has an intention tremor of the right hand."
- B. "Right-hand tremor worsens with purposeful acts."
- C. "Needs assistance with dressing and eating due to severe trembling and clumsiness."
- D. "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup."
Correct Answer: D
Rationale: The most detailed and accurate documentation is: "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup," as it describes the intention tremor specifically and legally.
A client who has a history of mitral valve prolapse tells the nurse that she is scheduled to get her teeth cleaned. Which of the following replies by the nurse is most appropriate?
- A. The physician will need to reevaluate the status of your heart condition before your dental appointment.'
- B. The nurse to remind your dentist that you have a heart condition.'
- C. It is important for you to care for your teeth because your heart condition makes you more susceptible to developing oral infections.'
- D. We will prescribe a prophylactic antibiotic for you to take before getting your teeth cleaned.'
Correct Answer: D
Rationale: Clients with mitral valve prolapse may require prophylactic antibiotics before dental procedures to prevent infective endocarditis, depending on current guidelines. This is the most appropriate response as it directly addresses the need for preventive measures. The other options either lack specificity or do not address the immediate clinical concern.
The nurse is teaching a client with a total knee replacement about incision care. Which statement by the client indicates a need for further teaching?
- A. I'll keep the incision clean and dry.'
- B. I'll report redness or drainage.'
- C. I'll change the dressing weekly.'
- D. I'll avoid soaking the incision.'
Correct Answer: C
Rationale: Changing the dressing weekly is too infrequent; daily or as-needed changes are required to monitor for infection.
A client who had a splenectomy is being discharged. Of the following discharge instructions, which is most specific to the client's surgical procedure?
- A. Do not drive.
- B. Alternate rest and activity.
- C. Make an appointment for the staples to be removed.
- D. Report early signs of infection.
Correct Answer: D
Rationale: Splenectomy increases the lifelong risk of infection due to the spleen's role in immunity. Reporting early signs of infection is the most specific instruction, as it addresses this unique risk. The other instructions are general postoperative advice.
Post-cystectomy, a client asks about the purpose of the ileal conduit. The nurse explains it is to:
- A. Store urine in the bladder.
- B. Divert urine to an external pouch.
- C. Filter blood in the kidneys.
- D. Reabsorb water in the intestines.
Correct Answer: B
Rationale: An ileal conduit diverts urine from the ureters to a stoma, collected in an external pouch.