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Which of these statements by the nurse is incorrect if the nurse has the goal to reinforce information about cancers to a group of young adults?
- A. You can reduce your risk of this serious type of stomach cancer by eating lots of fruits and vegetables, limiting all meat, and avoiding nitrate-containing foods.
- B. Prostate cancer is the most common cancer in American men with results to threaten sexuality and life.
- C. Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.
- D. Lung cancer is the leading cause of cancer deaths in the United States. Yet it's the most preventable of all cancers.
Correct Answer: A
Rationale: It is recommended that only red meat be limited for the prevention of stomach cancer. All of the other statements offer correct information.
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A mother brings her 17-month-old son to the well-baby clinic for a routine check-up. She confides to the nurse that she is concerned because her son sucks his thumb, especially at night when he is put to bed.
Which of the suggestions by the nurse would be BEST?
- A. If you want the behavior to stop put a negative reinforcer, such as red pepper, on this thumb.'
- B. Don't intervene at this time. This behavior usually subsides after 24 months of age.'
- C. What you are seeing is a common form of self-stimulation. You should discourage this behavior.'
- D. This behavior will cause malformation of his teeth. You should wrap his thumb at bedtime.'
Correct Answer: B
Rationale: Strategy: 'BEST' indicates there may be more than one correct response. Remember growth and development concepts. (1) controversial treatment for an older child (2) correct-normal behavior, peaks at 18-20 months, most prevalent when child is hungry or tired (3) normal behavior in child this age, should not be discouraged (4) malocclusion occurs if thumb sucking persists past 4 years old or when permanent teeth erupt
A client is being treated for hypovolemia.
Which of the following observations should the nurse identify as the desired response to fluid replacement?
- A. Urine output 160 cc/8 h.
- B. Hgb 11 g, Hct 33%.
- C. Arterial pH 7.34.
- D. CVP reading of 8 cm of water pressure.
Correct Answer: D
Rationale: Strategy: Determine the significance of each answer choice and how it relates to hypovolemia. (1) indicates a hypovolemic state (2) indicates a hypovolemic state (3) indicates acidosis (4) correct-normal range for CVP is 3-8 cm water pressure (or 2-6 mm Hg); reading of 8 cm water pressure would indicate a desired response to fluid replacement
A client comes to the clinic for treatment of recurrent pelvic inflammatory disease (PID). The nurse recognizes that this condition most frequently follows which type of infection?
- A. Trichomoniasis
- B. Chlamydia
- C. Staphylococcus
- D. Streptococcus
Correct Answer: B
Rationale: Chlamydia. Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease.
The nurse is caring for a client who is receiving IV vancomycin for a methicillin-resistant Staphylococcus aureus (MRSA) infection. Which of the following findings should the nurse report immediately?
- A. Mild redness at the IV site.
- B. Temperature of 100.8°F (38.2°C).
- C. Urine output of 50 mL/hour.
- D. Blood pressure of 130/80 mmHg.
Correct Answer: B
Rationale: A temperature of 100.8°F suggests worsening infection, requiring immediate reporting. Options A, C, and D are less urgent or normal.
An adult male is admitted with urolithiasis. The nurse expects which orders for this client? Select all that apply.
- A. Push fluids
- B. Strain all urine
- C. Medicate for pain PRN
- D. Clean catch daily
- E. Daily catheterizations
- F. Clear liquid diet
Correct Answer: A,B,C
Rationale: Pushing fluids promotes stone passage, straining urine captures stones for analysis, and pain medication addresses colic in urolithiasis. Clean catch, catheterization, or clear liquids are not standard.