Nokea
Which of these clients assigned to the nurse is most likely to need planning for long-term nursing management?
- A. 22-year-old with appendicitis who has had an emergency appendectomy
- B. 56-year-old with bilateral knee osteoarthritis who weighs 159 kg
- C. 34-year-old with cholecystitis who has had a laparoscopic cholecystectomy
- D. 62-year-old with acute sinusitis who will require antibiotic therapy for 5 days
Correct Answer: B
Rationale: Osteoarthritis at 159 kg screams chronic long-term PT, diet plans beat appendectomy, gallbladder, or sinus quickies. Nurses plot this, a marathon, not sprints.
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When educating a female client on the signs and symptoms of myocardial infarction, the nurse recognizes which of the following should be included in the teaching?
- A. Pain usually resolves with rest and relaxation
- B. Older adults and women often present with atypical signs and symptoms
- C. Women experience intermittent claudication
- D. Substernal chest pain is the most common symptom in women
Correct Answer: B
Rationale: MI in women skews odd fatigue, nausea, not just chest pain, hit older females especially, a teaching must as atypical signs delay care. Rest eases angina, not MI. Claudication's PAD, not heart. Substernal pain's common, less so in women. Nurses stress this quirk, boosting recognition in this sneaky killer.
The nurse caring for oncology clients knows that which form of metastasis is the most common?
- A. Bloodborne
- B. Direct invasion
- C. Lymphatic spread
- D. Via bone marrow
Correct Answer: A
Rationale: Metastasis is the process by which cancer spreads from its original site to distant parts of the body, a critical concern in oncology nursing. Among the various mechanisms, bloodborne metastasis is the most common, as cancer cells often enter the bloodstream and travel to organs like the lungs, liver, or brain. This occurs because the circulatory system provides an efficient pathway for tumor cells to disseminate widely, especially in cancers like breast or lung cancer. Lymphatic spread is also frequent, particularly in carcinomas, where cells travel via lymph nodes, but it is less dominant than bloodborne spread across all cancer types. Direct invasion involves cancer growing into adjacent tissues, which is a local process rather than true metastasis. Bone marrow is not a medium for metastasis but a potential site where cancer can settle, such as in leukemia or multiple myeloma. Understanding that bloodborne metastasis predominates helps nurses prioritize monitoring for systemic symptoms and complications, such as organ dysfunction, in clients with advanced cancer.
Which is not associated with atypical pneumonia?
- A. abnormal LFTs
- B. hypernatremia
- C. hypophosphatemia
- D. bilateral patchy infiltrates on CXR
Correct Answer: B
Rationale: Atypical pneumonia LFTs wobble, phosphates drop, CXR patches, agglutinins rise; sodium stays. Nurses skip this chronic salt glitch.
It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
A nurse is performing discharge teaching for a client who was recently diagnosed with heart failure. Which of the following should be included in the client and family teaching?
- A. Low sodium diet
- B. Weekly weights
- C. Symptoms to report to the provider
- D. Fluid restriction
Correct Answer: A
Rationale: Heart failure management hinges on education to prevent exacerbations. A low sodium diet reduces fluid retention, easing cardiac workload crucial teaching for clients and families to grasp, as salt drives edema and hypertension, common pitfalls in heart failure. Weekly weights track fluid shifts daily is ideal, but weekly still aids while reporting symptoms like dyspnea flags worsening. Medication teaching ensures adherence, and fluid restriction may apply, but sodium's broader impact makes it foundational. Focusing on diet empowers lifestyle change, tackling a root cause over monitoring or restrictions alone, aligning with nursing's role in empowering self-care to stabilize this chronic condition long-term.