Nokea
Which symptom suggests worsening neurological status in a client with a head injury?
- A. Improved orientation.
- B. Decreased pulse rate.
- C. Stable blood pressure.
- D. Mild fatigue.
Correct Answer: B
Rationale: Decreased pulse rate (bradycardia) may indicate increased intracranial pressure, a sign of worsening neurological status.
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A client is newly diagnosed with cancer and is beginning a treatment plan. Which of the following nursing interventions will be most effective in helping the client cope?
- A. Assume decision making for the client.
- B. Encourage the client's compliance with all treatment regimens.
- C. Inform the client of all possible adverse treatment effects.
- D. Identify available resources.
Correct Answer: D
Rationale: Identifying available resources (e.g., support groups, counseling) empowers the client to cope with the emotional and practical challenges of a new cancer diagnosis.
The nurse is caring for a client with herpes simplex virus who is experiencing an outbreak. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe?
- A. Metronidazole
- B. Acyclovir
- C. Imiquimod
- D. Fluconazole
Correct Answer: B
Rationale: Acyclovir is an antiviral medication used to treat herpes simplex virus (HSV) infections. Choice A (metronidazole) is used for bacterial and parasitic infections, Choice C (antibiotic) is for topical treatment of genital warts, and Choice D (fluconazole) is an antifungal for yeast infections.
The nurse is a member of a team that is planning a client-centered approach to care of clients with chronic obstructive pulmonary disease (COPD) using the Chronic Care Model (CCM). The team should focus on improving quality of care and delivery in which of the following areas? Select all that apply.
- A. The community.
- B. Clinical information systems.
- C. Delivery system design.
- D. Administrative leadership.
- E. Emphasis on the acute care setting.
Correct Answer: A,B,C
Rationale: The Chronic Care Model emphasizes community resources (A), clinical information systems (B), and delivery system design (C) for chronic disease management. Administrative leadership and acute care focus are less central.
To decrease intraocular pressure following cataract surgery, the nurse should instruct the client to avoid:
- A. Lying supine.
- B. Coughing.
- C. Deep breathing.
- D. Ambulation.
Correct Answer: B
Rationale: Coughing increases intraocular pressure by causing a Valsalva maneuver, which can strain the surgical site and lead to complications like hemorrhage or wound dehiscence.
Which activity should a client with an ileal conduit avoid?
- A. Swimming.
- B. Walking.
- C. Heavy lifting.
- D. Reading.
Correct Answer: C
Rationale: Heavy lifting can strain the stoma site, increasing hernia risk.