Mixed Topics

A client has a routine Papanicolaou (Pap) test during a yearly gynecologic examination. The result reveals a class V finding. What should the nurse tell the client about this finding? a) It calls for a biopsy as soon as possible. b) It calls for a repeat Pap test in 3 months. c) It's normal and requires no action. d) It calls for a repeat Pap test in 6 weeks.

a) It calls for a biopsy as soon as possible. A class V finding in a Pap test suggests probable cervical cancer; the client should have a biopsy as soon as possible. Only a class I finding, which is normal, requires no action. A class II finding, which indicates inflammation, calls for a repeat Pap test in 3 months. A class III finding, which indicates mild to moderate dysplasia, calls for a repeat Pap test in 6 weeks to 3 months. A class IV finding indicates possible cervical cancer; like a class V finding, it warrants a biopsy as soon as possible.

Twenty-four hours after a bone marrow aspiration, the nurse evaluates which client outcome as an appropriate one? a) The client requests a strong analgesic for pain. b) There is no bleeding at the aspiration site. c) There is redness and swelling at the aspiration site. d) The client maintains bed rest.

b) There is no bleeding at the aspiration site. After a bone marrow aspiration, the puncture site should be checked every 10 to 15 minutes for bleeding. For a short period after the procedure, bed rest may be prescribed. Signs of infection, such as redness and swelling, are not anticipated at the aspiration site. A mild analgesic may be prescribed for pain, but if the client has pain longer than 24 hours, the nurse should assess the client for internal bleeding or increased pressure at the puncture site which may be the cause of the pain and should consult the health care provider (HCP).

A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would be most therapeutic for the client? a) respecting his need for privacy b) discussing his behavior with his wife to determine the cause c) exploring his future plans d) encouraging him to express his feelings nonverbally and in writing

d) encouraging him to express his feelings nonverbally and in writing The client has undergone body changes and permanent loss of verbal communication. He may feel isolated and insecure. The nurse can encourage him to express his feelings and use this information to develop an appropriate plan of care. Discussing the client's behavior with his wife may not reveal his feelings. Exploring future plans is not appropriate at this time because more information about the client's behavior is needed before proceeding to this level. The nurse can respect the client's need for privacy while also encouraging him to express his feelings.

When a client returns from the recovery room postmastectomy, an initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment? a) Assessing the vital signs and oxygen saturation levels b) Checking the dressing, drain, and amount of drainage c) Assessing for urinary retention and the need to void d) Checking the level of pain first upon the client's return from the operating room

a) Assessing the vital signs and oxygen saturation levels This correct response is based on principles of ABCs. The return of urinary function after anesthesia usually takes 6 or more hours, so this assessment is not a priority upon return from the recovery room. Checking the dressing and level of pain are both important, but not the priority.

When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include: a) delayed gastric emptying. b) increased coronary artery blood flow. c) decreased peripheral resistance. d) decreased posterior thoracic curve.

a) delayed gastric emptying. Aging-related physiologic changes include delayed gastric emptying, decreased coronary artery blood flow, an increased posterior thoracic curve, and increased peripheral resistance.

A 70-year-old client asks the nurse if she needs to have a mammogram. Which is the nurse's best response? a) "Having a mammogram when you are older is less painful." b) "The incidence of breast cancer increases with age." c) "We need to consider your family history of breast cancer first." d) "It will be sufficient if you perform breast examinations monthly."

b) "The incidence of breast cancer increases with age." The nurse should explain that the incidence of breast cancer increases with age and current guidelines recommend women have a mammogram every 2 years until age 74. While mammograms are less painful as breast tissue becomes softer, the nurse should advise the woman to have the mammogram. Family history is important, but only about 5% of breast cancers are genetic.

After a 3-month trial of dietary therapy, a client with type 2 diabetes still has blood glucose levels above 180 mg/dl (9.99mmol/L). The physician adds glyburide, 2.5 mg P.O. daily, to the treatment regimen. The nurse should instruct the client to take the glyburide: a) 30 minutes after dinner. b) in mid-morning. c) at breakfast. d) at bedtime.

c) at breakfast. Like other oral antidiabetic agents ordered in a single daily dose, glyburide should be taken with breakfast. If the client takes glyburide later, such as in mid-morning, after dinner, or at bedtime, the drug won't provide adequate coverage for all meals consumed during the day.

A client, age 75, is admitted to the hospital. Because of the client's age, the nurse should modify the assessment by: a) speaking loudly and slowly. b) addressing the client by his first name. c) shortening it due to possible client fatigue. d) allowing extra time for the assessment.

d) allowing extra time for the assessment. When assessing an elderly client, the nurse should allow extra time to compensate for aging-related physiologic changes, address the client respectfully rather than by his first name, and give simple instructions. Speaking in a loud voice is demeaning and assumes that the client has difficulty hearing, which may not be the case.

Before the nurse administers IV replacement of 5% dextrose in water with potassium chloride, what nursing intervention must be completed first? a) priming tubing using sterile technique b) checking the rate for IV push administration. c) adding potassium chloride to the bag at the bedside d) evaluating laboratory results for electrolytes

d) evaluating laboratory results for electrolytes IV solutions are prescribed based upon the fluid and electrolyte status of the client, so laboratory results should be monitored first. Safety recommendations are for standard premixed solutions. If solutions are not premixed, additives are completed by the pharmacy, not at the bedside. Potassium chloride is never given by IV push because this could be fatal. Administration guidelines require no more than 10 mEq (10 mmol/L) of potassium chloride be infused per hour on a general medical-surgical unit. An infusion device or pump is required for safe administration.

After a mastectomy for breast cancer, the nurse teaches the client how to avoid the development of lymphedema. Which of the following instructions should be included? a) Elevating the affected arm on a pillow. b) Limiting range-of-motion exercises in the shoulder and elbow. c) Taking diuretics as necessary to decrease swelling. d) Applying an elastic bandage to the affected extremity.

a) Elevating the affected arm on a pillow. The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area. Applying an elastic bandage is inappropriate because constriction of the extremity should be avoided. Range-of-motion exercising is not limited. Rather, it is encouraged. Diuretics are not used to control lymphedema.

A client with Raynaud's phenomenon is considering having a sympathectomy. This nurse should tell the client that the surgery is performed: a) when the disease is controlled by medication. b) when all other treatment alternatives have failed. c) in the early stages of the disease to prevent further circulatory disturbances. d) when the client is unable to control stress-related vasospasm.

b) when all other treatment alternatives have failed. Sympathectomy is scheduled only after other treatment alternatives have been explored and have failed. Medication and stress management are beneficial strategies to prevent advancement of the disease process. If the disease is controlled by medication, there is no reason for surgery.

When teaching a client when to take glipizide in order to maximize the effectiveness of the drug, the nurse should instruct the client to: a) Take glipizide 30 minutes before breakfast. b) Take glipizide four times a day, at evenly spaced intervals. c) Take glipizide immediately after meals. d) Take glipizide as indicated by blood glucose values.

a) Take glipizide 30 minutes before breakfast. Glipizide is most effective when taken 30 minutes before breakfast. The duration of action is 10 to 24 hours. If the drug needs to be taken more than once a day, the dosage may be divided and taken twice a day before meals. It is not as effective to take the drug after meals. Although blood glucose levels will be monitored, the values do not dictate when the drug should be taken

A client has been experiencing abdominal cramps, diarrhea, and concentrated urine for the past 2 days. Which of the following would be included in a focused assessment? a) Signs of kidney suppression with enlargement of the kidneys, reduced urine flow, and concentrated urine b) Signs of abdominal distension, auscultation of reduced bowel sounds, and tympany upon percussion c) Signs of metabolic alkalosis with disorientation because of loss of intestinal fluids d) Signs of dehydration, including loss of weight; poor tissue turgor; and dry, cracked mucous membranes

d) Signs of dehydration, including loss of weight; poor tissue turgor; and dry, cracked mucous membranes When a client has abdominal cramps and diarrhea, there is a loss of extra fluids from the body. Through a focused assessment, the nurse should assess for a fluid volume deficit. This would be indicated by signs of dehydration and weight loss. A focused assessment would usually indicate increased bowel sounds associated with the cramping. Kidney suppression would not be associated with diarrhea lasting 2 days; it might present with severe dehydration and hypovolemic shock. There is a loss of bicarbonate through the diarrhea, which would result in metabolic acidosis, not alkalosis.

The nurse notes serous discharge when an abdominal dressing is changed. The nurse would document this drainage as which of the following? a) Tenacious and yellow drainage b) Clear, watery, yellow-tinged drainage c) Dark melena and foul smelling d) White with sanguineous drainage

b) Clear, watery, yellow-tinged drainage Serous drainage is clear, watery plasma; sanguineous drainage is fresh, red bleeding; purulent drainage is thick and yellow; and purulent drainage with infection is beige to brown and foul smelling. White with sanguinous drainage and tenacious with yellow drainage are both indicative of an infection. Dark melena and foul smelling is indicative of a gastrointestinal bleed.

A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? a) Anemia b) Chronic obstructive pulmonary disease (COPD) c) A bleeding disorder d) A seizure disorder

c) A bleeding disorder A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis.

The nurse is assessing a 60-year-old male who has hoarseness. The nurse should conduct a focused assessment to determine: a) Patterns of medication use and history of alcohol consumption. b) Exposure to wood dust and a high-fat diet. c) History of tobacco use and alcohol consumption. d) Exposure to sun and family history of head and neck cancers.

c) History of tobacco use and alcohol consumption. Although exposure to the sun increases the risk of skin cancers and family history is significant in the development of some types of cancer, heavy tobacco use and alcohol intake have a synergistic effect and increase the risk and incidence of head and neck cancers. Patterns of medication use, exposure to wood dust, and a high-fat diet are not associated with an increased risk and incidence of head and neck cancers.

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? a) angiotensin-converting enzyme (ACE) inhibitors b) aspirin c) steroids d) sulfonylureas

c) steroids Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.

A deficiency of which vitamin is thought to be the first step in the formation of plaque and oxidative changes in the arteries? a) vitamin C b) vitamin B6 c) vitamin E d) vitamin A

c) vitamin E Vitamin E is a powerful antioxidant that helps to prevent oxidation of the cell membrane. Vitamins C, A, and B6 are helpful in the prevention of heart disease, but vitamin E plays a more important role.

Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes that he has no active gag reflex. In response, the nurse should: a) insert an oral airway. b) introduce a nasogastric (NG) tube. c) position the client on his side. d) withhold food and fluids.

d) withhold food and fluids. Following a transesophageal echocardiogram in which the client's throat has been anesthetized, the nurse should withhold food and fluid until the client's gag reflex returns. There's no indication that oral airway placement would be appropriate. The client should be in the upright position, and the nurse needn't insert an NG tube.

A client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed? a) Withhold the medication and cancel the procedure. b) Withhold the medication and notify the physician immediately. c) Explain that cardiac catheterization does not involve open heart surgery, and then medicate the client. d) Medicate the client and document his comment.

b) Withhold the medication and notify the physician immediately. The nurse should withhold the medication and notify the physician that the client does not understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client does not understand, he cannot give a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse may not just medicate the client and document the finding; the physician must be notified. The procedure does not need to be cancelled, only postponed until the client receives more education and is able to give informed consent.

Clients who are receiving total parenteral nutrition (TPN) are at risk for development of which complication? a) orthostatic hypotension b) pulmonary hypertension c) fluid imbalances d) hypostatic pneumonia

c) fluid imbalances Clients receiving TPN are at risk for a number of complications, including fluid imbalances such as fluid overload and hyperosmolar diuresis. Other common complications include hyperglycemia, sepsis, pneumothorax, and air embolism. Hypostatic pneumonia, pulmonary hypertension, and orthostatic hypotension are not complications of TPN.

A nurse is caring for a client with a long-term central venous catheter. Which steps should the nurse include in teaching how to care for his catheter at home? a) If the needle becomes contaminated before accessing the port, clean the needle with povidone-iodine solution. b) Flush each port using a 10ml NSS syringe, giving each port 5ml from the syringe. c) Use clean technique when accessing the port with a needle. d) Clean the port with an alcohol pad before administering I.V. fluid through the catheter.

d) Clean the port with an alcohol pad before administering I.V. fluid through the catheter. Clients should be instructed to clean the port with an alcohol pad before administering I.V. fluid through the catheter to prevent microorganisms from entering the bloodstream. Using clean technique when accessing the port with a needle, cleaning the needle with a povidone-iodine solution, or flushing each port using the same syringe would break sterile technique.