Nokea
Which teaching point is critical for a client with a new diagnosis of epilepsy?
- A. Avoid driving until seizures are controlled.
- B. Limit all social activities.
- C. Discontinue medications if seizures stop.
- D. Restrict fluid intake.
Correct Answer: A
Rationale: Avoiding driving until seizures are controlled is critical for safety in epilepsy management.
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A common abnormal laboratory result associated with the development of peripheral vascular disease (PVD) is:
- A. High serum calcium level
- B. High serum lipid levels
- C. Low serum lipid levels
- D. Low serum calcium level
Correct Answer: B
Rationale: High serum lipid levels, particularly elevated low-density lipoprotein (LDL) cholesterol, are a major risk factor for atherosclerosis, which underlies PVD. Lipid accumulation in arterial walls leads to plaque formation, narrowing vessels and reducing blood flow. Calcium levels are not directly associated with PVD, and low lipid levels are not a risk factor.
A client post-lithotripsy asks about expected symptoms. The nurse should explain:
- A. Bruising at the site.
- B. Severe flank pain.
- C. Clear urine output.
- D. Fever above 102°F.
Correct Answer: A
Rationale: Bruising is common post-lithotripsy due to shock wave impact on tissues.
The nurse notes a client's preoperative hemoglobin is 9.8 g/dL. What is the priority nursing action?
- A. Administer iron supplements as ordered.
- B. Notify the surgeon of the result.
- C. Encourage a high-protein diet.
- D. Document the finding and continue preparations.
Correct Answer: B
Rationale: A hemoglobin of 9.8 g/dL indicates anemia, which increases surgical risks. Notifying the surgeon ensures evaluation and possible intervention before proceeding.
A severe acute respiratory syndrome (SARS) epidemic is suspected in a community of 10,000 people. As clients with SARS are admitted to the hospital, what type of precautions should the nurse institute?
- A. Historic precautions.
- B. Hand-washing precautions.
- C. Reverse isolation.
- D. Standard precautions.
Correct Answer: D
Rationale: SARS requires standard precautions plus airborne and contact precautions, but standard precautions are the baseline for all patients to prevent transmission.
A client who has had her jaws wired begins to vomit. What should be the nurse's first action?
- A. Insert a nasogastric (NG) tube and connect it to suction.
- B. Use wire cutters to cut the wire.
- C. Suction the client's airway as needed.
- D. Administer an antiemetic intravenously.
Correct Answer: C
Rationale: Suctioning the airway is the first action to prevent aspiration in a client with wired jaws who is vomiting. Cutting the wires is a last resort, and the other options do not address the immediate risk of airway obstruction.