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Why does the nurse advise a client with painless lesions, after exposure to anthrax, to avoid contact with others?
- A. So the client is not exposed to pathogens.
- B. Because the sight of the lesions may cause distress and panic.
- C. Because the lesions may release more spores.
- D. Skin infection is one form of anthrax that spreads by direct contact.
Correct Answer: C
Rationale: The correct answer is C because anthrax lesions can release spores that may infect others.
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A client is considering laser abdominal surgery and asks the nurse if there is any advantage in having this type of surgery. The nurse's response should be based upon the knowledge that laser surgery:
- A. has a smaller postoperative infection rate than routine surgery.
- B. will eliminate the need for preoperative sedation.
- C. will result in less operating time.
- D. generally eliminates problems and complications.
Correct Answer: A
Rationale: A lower postoperative infection rate has been documented as a result of laser therapy versus routine surgery. Clients who choose laser surgery will still need preoperative sedation to facilitate anxiety reduction. Operating time may actually increase in some laser surgeries. The client who chooses laser surgery must still be observed for postoperative complications.
What are the criteria for diagnosing systemic inflammatory response syndrome (SIRS)?
- A. Dehydration
- B. Overhydration
- C. Electrolyte imbalance
- D. Hypertension
Correct Answer: A
Rationale: Dehydration results from fluid loss exceeding intake, causing symptoms like dry mucous membranes, poor skin turgor, and hypotension.
Which is an essential component of quality care for dying clients?
- A. Assist the client with personal hygiene.
- B. Inform all members of healthcare regarding the client’s prognosis.
- C. Provide sensitivity and compassion for the client and their family members.
- D. Promote the care of dying clients at home or in hospice settings.
Correct Answer: C
Rationale: Sensitivity and compassion address emotional and psychological needs, enhancing end-of-life care.
A client is experiencing episodes of hyperventilation related to the surgery scheduled for tomorrow. The appropriate nursing action to help control hyperventilation is to:
- A. administer Valium 10-15 mg PO q4h and q1h prn.
- B. keep the temperature in the client's room high to reduce respiratory stimulation.
- C. have the client hold their breath or breathe into a paper bag when the hyperventilation episodes occur.
- D. use distractions.
Correct Answer: C
Rationale: An adult Valium dosage for treatment of anxiety is 2-10 mg PO from two to four times daily. As written, the order would place a client at risk for an overdose. A high room temperature could increase the hyperventilating episodes by stimulating the respiratory system. Holding one's breath and breathing into a paper bag may be useful in controlling hyperventilation. Both measures increase CO2 retention. Distraction will not prevent or control hyperventilation, which is caused by anxiety or fear.
Which statement best describes emmetropia?
- A. Difficulty with near vision
- B. Difficulty with far vision
- C. Visual distortion caused by an irregularly shaped cornea
- D. Normal vision
Correct Answer: D
Rationale: Emmetropia refers to normal vision where light focuses correctly on the retina without refractive error.