Nokea
Which of these clients would the nurse monitor for the complication of C. difficile diarrhea?
- A. An adolescent taking medications for acne
- B. An elderly client living in a retirement center taking prednisone
- C. A young adult in the second trimester of pregnancy
- D. A middle-aged client receiving radiation for throat cancer
Correct Answer: D
Rationale: A middle-aged client receiving radiation for throat cancer. Radiation therapy, particularly to the abdomen or pelvis, can disrupt the gut microbiota and increase the risk of C. difficile infection, especially if the client is also receiving antibiotics or has a weakened immune system.
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A 32-year-old man comes to the clinic for a glycosylated hemoglobin assay (HbA1c). The result is 6%. The nurse should
- A. document the findings in the chart.
- B. call the physician about orders to adjust the insulin dosage.
- C. give him 15 g of carbohydrates.
- D. ask him to list the foods he has eaten in the last 24 hours.
Correct Answer: A
Rationale: An HbA1c of 6% indicates good diabetes control (normal 4–6%). Documenting is appropriate as no action is needed. Options B, C, and D are unnecessary.
An adult is admitted with histoplasmosis. What is most likely to be in the client's history because he has histoplasmosis?
- A. He is a chicken farmer.
- B. He ate raw shellfish recently.
- C. He consumed contaminated water.
- D. He drinks raw milk.
Correct Answer: A
Rationale: Histoplasmosis is caused by inhaling Histoplasma spores, often found in bird or bat droppings, common in chicken farming environments, unlike shellfish, water, or milk.
The nurse is working in a surgeon's office and talking with a client who is scheduled for surgery in two weeks. The nurse asks about medications and supplements the client may be taking. What medication(s) the client reports would be of most concern to the nurse? Select all that apply.
- A. Acetaminophen
- B. Ibuprofen
- C. Vitamin C
- D. Vitamin E
- E. Ginseng
- F. Vitamin B complex
Correct Answer: B,D,E
Rationale: Ibuprofen, Vitamin E, and ginseng increase bleeding risk, posing concerns for surgical hemostasis.
The nurse is caring for clients(width)clients in the pediatric clinic.
- A. Which cranial nerve should the nurse assess in an infant with a 'crooked' smile?
- B. III.
- C. V.
- D. VII.
- E. XI.
Correct Answer: C
Rationale: A crooked smile in an infant suggests facial muscle weakness, controlled by the facial nerve (VII), which governs facial expressions. Cranial nerves III (eye movement), V (sensation), and XI (neck/shoulder movement) are unrelated to smiling.
A client is being treated for cancer with linear acceleration radiation. The physician has marked the radiation site with a blue marking pen. The nurse should:
- A. Remove the unsightly markings with acetone or alcohol.
- B. Cover the radiation site with loose gauze dressing.
- C. Sprinkle baby powder over the radiated area.
- D. Refrain from using soap or lotion on the marked area.
Correct Answer: D
Rationale: Refraining from using soap or lotion preserves radiation site markings, ensuring accurate treatment. Removing markings, covering, or using powder risks disrupting the treatment field.