Nokea
While teaching the client, what can the nurse explain about the purpose for prescribing this medication?
- A. To reduce emotional depression
- B. To relax skeletal muscles
- C. To promote restful sleep
- D. To relieve inflammation
Correct Answer: B
Rationale: Cyclobenzaprine (Flexeril) is a muscle relaxant used to reduce muscle spasms associated with a herniated disk, alleviating pain and improving mobility. It does not primarily address depression, sleep, or inflammation.
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Which instruction should the nurse reinforce to ensure that the exercises are done correctly?
- A. Move your toes toward and away from your head.
- B. Contract and relax your thigh muscles.
- C. The client's effect on the use of the head.
- D. Bend your knee and pull your lower leg upward.
Correct Answer: B
Rationale: Isometric quadriceps-setting exercises involve contracting and relaxing the thigh muscles without joint movement, strengthening the muscle while minimizing stress on the surgical site. The other options describe different movements.
The client is admitted to the hospital for a diagnostic workup. The client has vague symptoms of malaise, coughing, chest discomfort, low-grade fever, diffuse rashes, and musculoskeletal aches and pains. A diagnosis of probable lupus erythematosus has been made. The night nurse finds the client crying and saying, 'I would rather die than suffer with this disease for the rest of my life.' Which response by the nurse would be most therapeutic at this time?
- A. Telling the client there are support groups to join after discharge
- B. Offering to stay with the client to discuss concerns and questions
- C. Advising the client to write concerns on paper to discuss with the doctors and nurses tomorrow
- D. Offering the client a back rub and a warm cup of milk
Correct Answer: B
Rationale: Offering to stay and discuss concerns is therapeutic, providing emotional support and addressing the client's fears.
The nurse identifies a concept of impaired mobility for a male client with degenerative disk disease. Which assessment data best support this concept?
- A. The client reports a history of chronic back pain and multiple back surgeries.
- B. The client reports that taking NSAIDs caused the development of peptic ulcers.
- C. The client reports a three (3)-year history of difficulty initiating a urinary stream.
- D. The client states he fell a year ago and had to have a cast on the right arm for a month.
Correct Answer: A
Rationale: Chronic back pain and surgeries directly impair mobility in degenerative disk disease. Ulcers, urinary issues, and past arm fractures are unrelated to current mobility.
Postoperatively, the client screams obscenities at the nurse after realizing that the injured forearm is missing. Which nursing action is most appropriate at this time?
- A. Leave until the client works through the anger.
- B. Stay quietly with the client at the bedside.
- C. Tell the client to gain emotional control.
- D. Call the physician and request a sedative.
Correct Answer: B
Rationale: Staying quietly with the client provides emotional support during a grief reaction to amputation, promoting trust. Leaving, reprimanding, or medicating without engagement dismisses the client's feelings.
Which is most important for the nurse to include in the child's plan of care for a child with spina bifida (myelodysplasia)?
- A. Avoid the child's exposure to latex.
- B. Do intermittent urinary catheterization.
- C. Provide dietary fiber supplements daily.
- D. Complete a referral for physical therapy.
Correct Answer: A
Rationale: Avoiding latex exposure is critical due to the high risk of latex allergy in children with spina bifida.