A 21-year-old male with Hodgkin’s lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client? A. Sexual dysfunction related to radiation therapy B. Anticipatory grieving related to terminal… Read More »
A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in 4 months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority? A. Impaired physical mobility related to decreased endurance… Read More »
The client is having an arteriogram. During the procedure, the client tells the nurse, “I’m feeling really hot.” Which response would be best? A. “You are having an allergic reaction. I will get an order for Benadryl.” B. “That feeling of warmth is normal when the dye is injected.” C. “That feeling of… Read More »
The nurse is observing several healthcare workers providing care. Which action by the healthcare worker indicates a need for further teaching? A. The nursing assistant wears gloves while giving the client a bath. B. The nurse wears goggles while drawing blood from the client. C. The doctor washes his hands before examining… Read More »
The client is having electroconvulsive therapy for treatment of severe depression. Which of the following indicates that the client’s ECT has been effective? A. The client loses consciousness. B. The client vomits. C. The client’s ECG indicates tachycardia. D. The client has a grand mal seizure. Correct… Read More »
The 5-year-old is being tested for enterobiasis (pinworms). To collect a specimen for assessment of pinworms, the nurse should teach the mother to: A. Examine the perianal area with a flashlight 2 or 3 hours after the child is asleep B. Scrape the skin with a piece of cardboard and bring it to… Read More »
The nurse is teaching the mother regarding treatment for enterobiasis. Which instruction should be given regarding the medication? A. Treatment is not recommended for children less than 10 years of age. B. The entire family should be treated. C. Medication therapy will continue for 1 year. D. Intravenous antibiotic therapy will… Read More »
A client has autoimmune thrombocytopenic purpura. To determine the client’s response to treatment, the nurse would monitor: A. Platelet count B. White blood cell count C. Potassium levels D. Partial prothrombin time (PTT) Correct Answer: A. Platelet count Clients with autoimmune thrombocytopenic purpura (ATP) have low platelet… Read More »
The client returns to the unit from surgery with a blood pressure of 90/50, pulse 132, and respirations 30. Which action by the nurse should receive priority? A. Continuing to monitor the vital signs B. Contacting the physician C. Asking the client how he feels D. Asking the LPN to continue… Read More »
The nurse is caring for a 6-year-old client admitted with a diagnosis of conjunctivitis. Before administering eye drops, the nurse should recognize that it is essential to consider which of the following? A. The eye should be cleansed with warm water, removing any exudate, before instilling the eyedrops. B. The child should be… Read More »