Saunders Ch 29 41 & 52 Practice Questions

The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which sign(s)/(symptom(s) of the client are associated with Hodgkin's disease? Select all that apply. 1. Fatigue 2. Joint pain 3. Weakness 4. Weight gain 5. Night sweats 6. Enlarged lymph nodes

1, 3, 5, 6 Rationale: Hodgkin's disease (lymphoma) is a chronic, progressive neoplastic disorder of the lymphoid tissue that is characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Other signs and symptoms include fatigue, weakness, weight loss, and night sweats. Weight gain and joint pain are not associated with Hodgkin's disease.

The nurse is assisting with creating a plan of care for the client with multiple myeloma. Which nursing intervention needs to be included to assess for and prevent renal failure for this client? Select all that apply. 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count 5. Monitoring serum calcium and uric acid levels

1, 5 Rationale: To prevent renal failure in the client with multiple myeloma, the nurse would encourage fluids and monitor serum calcium and uric acid levels. Hypercalcemia secondary to bone destruction is a priority concern in the client with multiple myeloma. The nurse needs to encourage fluids in adequate amounts to maintain an output of 1.5 to 2 L a day. Clients require approximately 3 L of fluid per day. The fluid is needed not only to dilute the calcium and uric acid but also to prevent protein from precipitating in the renal tubules. Oral care, encouraging coughing and deep breathing, and monitoring the red blood cell count are important for clients with cancer, but these interventions are not specific to prevention or assessment of renal failure.

The nurse is monitoring for bleeding in a child after surgery to remove a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which nursing action is appropriate? 1. Reinforce the dressing. 2. Notify the registered nurse (RN). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.

2 Rationale: Colorless drainage on the dressing would indicate the presence of cerebrospinal fluid and needs to be reported to the registered nurse (RN) immediately; the RN would then contact the primary health care provider. The colorless drainage would also be checked for evidence of cerebrospinal fluid; one method is to check for the presence of glucose using a dipstick. Options 1, 3, and 4 are incorrect and delay required immediate interventions.

Bethanechol chloride is prescribed for a client with urinary retention. Which health problem would be a contraindication to the administration of this medication? 1. Gastric atony 2. Urinary strictures 3. Neurogenic atony 4. Gastroesophageal reflux

2 Rationale: Bethanechol chloride can be harmful to clients with urinary tract obstruction or weakness of the bladder wall. The medication has the ability to contract the bladder and thereby increase pressure within the urinary tract. Elevation of pressure within the urinary tract could rupture the bladder in clients with these conditions.

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which are side/adverse effects of the external radiation? Select all that apply. 1. Dyspnea 2. Diarrhea 3. Sore throat 4. Constipation 5. Red and dry skin over neck

3, 5 Rationale: External radiation is used to treat cancer in a specific area by emission of ionizing radiation beams that destroy cancer cells and have minimal damage to the surrounding normal cells. The client receiving external radiation experiences both general side/adverse effects such as fatigue, nausea, and anorexia and localized side/adverse effects in the specific area receiving radiation. A client who is receiving radiation to the larynx is most likely to experience a sore throat and dry, reddened skin in the throat area. Diarrhea or constipation occur with radiation to the gastrointestinal (GI) tract. Dyspnea may occur with lung involvement.

The nurse reinforces instructions to the parents of a child with sickle cell anemia regarding the precipitating factors related to pain crisis. Which, if identified by a parent as a precipitating factor, indicates the need for further teaching? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

4 Rationale: Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or general stress. The mother of a child with sickle cell disease would encourage a fluid intake of 1.5 to 2 times the daily requirement to prevent dehydration.

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% 2. Platelet count of 400,000 mm3 3. White blood cell count of 6000 mm3 4. Blood urea nitrogen level of 15 mg/dL

1 Rationale: Epoetin alfa is synthetic erythropoietin, which the kidneys produce to stimulate red blood cell production in the bone marrow. It is used to treat anemia associated with chronic kidney disease. The normal hematocrit level is Male: 42% to 52% ; Female: 37% to 47% . Therapeutic effect is seen when the hematocrit reaches between 30% and 33% The normal platelet count is 150,000 to 400,000 mm3. The normal blood urea nitrogen level is 10 to 20 mg/dL. The normal white blood cell count is 5000 to 10,000 mm3. Platelet production, white blood cell production, and blood urea nitrogen do not respond to erythropoietin.

The nurse who is administering bethanechol chloride is monitoring for acute toxicity associated with the medication. The nurse would check the client for which sign of toxicity? 1. Dry skin 2. Dry mouth 3. Bradycardia 4. Signs of dehydration

3 Rationale: Toxicity (overdose) produces manifestations of excessive muscarinic stimulation such as salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension. Treatment includes supportive measures and the administration of atropine sulfate subcutaneously or intravenously.

The nurse is assisting with creating a plan of care for a client with pancytopenia as a result of chemotherapy. The nurse would suggest including which in the plan of care? Select all that apply. 1. Restricting all visitors 2. Restricting fluid intake 3. Restricting fresh fruits and vegetables in the diet 4. Applying a face mask to the client if outside the client room 5. Inserting an indwelling urinary catheter to prevent skin breakdown

3, 4 Rationale: A client who is experiencing pancytopenia (decrease in all blood cells types: red, white, and platelets) is at high risk for infection because of significantly low immunity. The client should not eat fresh fruits and vegetables because of the risk for ingesting bacteria. All foods need to be cooked thoroughly. The client would wear a mask when outside of the room, to avoid potential infection spread from persons in the hallways. Not all visitors are restricted, but the client is protected from people with known infections. Fluids need to be encouraged because dehydration increases the risk for infection. Invasive measures such as an indwelling urinary catheter would be avoided to prevent infection.

The client who has a cold is seen in the emergency department with an inability to void. Because the client has a history of benign prostatic hyperplasia, the nurse determines that the client needs to be questioned about the use of which class of medications? 1. Diuretics 2. Antibiotics 3. Antitussives 4. Decongestants

4 Rationale: Episodes of urinary retention can be triggered by certain medications such as decongestants, anticholinergics, and antidepressants. Diuretics, antibiotics, and antitussives generally do not trigger urinary retention. Retention also can be precipitated by other factors such as alcoholic beverages, infection, bed rest, and becoming chilled. Test-Taking Strategy: Focus on the subject, medications that cause urinary retention. The question is asking about medications that could exacerbate or contribute to urinary retention. Diuretics would help voiding; therefore, readily eliminate option 1. Antibiotics would have no effect at all, eliminating option 2. From the remaining options, recalling that medications that contain anticholinergics may cause urinary retention will direct you to option 4.

The nurse reinforces home care instructions to the parents of a 3-year-old child who has been hospitalized with hemophilia. Which statement by a parent indicates the need for further teaching? 1. "I will supervise my child closely." 2. "I will pad the corners of the furniture." 3. "I will remove household items that can easily fall over." 4. "I will avoid immunizations and dental hygiene treatments for my child."

4 Rationale: The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. Options 1, 2, and 3 are appropriate statements. The parents are also provided instructions regarding measures to take in the event of blunt trauma (especially trauma that involves the joints), and they are instructed to apply prolonged pressure to superficial wounds until the bleeding has stopped.

Phenazopyridine hydrochloride is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. Which instruction would the nurse reinforce to the client? 1. Take the medication at bedtime. 2. Take the medication before meals. 3. Discontinue the medication if a headache occurs. 4. A reddish-orange discoloration of the urine may occur.

4 Rationale: The nurse would instruct the client that a reddish-orange discoloration of urine may occur. The nurse also would instruct the client that this discoloration can stain fabric. The medication needs to be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication.

The nurse is providing discharge instructions to the parents of a 14-year-old child who is undergoing radiation for Hodgkin's disease. Which statement by a parent indicates the need for further teaching? 1. "I need to watch for diarrhea, so my child does not get dehydrated." 2. "I think that once my child's hair starts to fall out that I can keep a hat on him." 3. "I understand that the radiation will cause nausea and vomiting and I need to keep my child hydrated." 4. "I will need to keep my child's skin from flaking, so we will be allowing showers every 2 or 3 days."

4 Rationale: The side effects of radiation therapy include dry or moist desquamation (peeling of the skin) and the intervention includes washing the skin daily, using mild soap, applying a lubricant as prescribed. Options 1, 2, and 3 are appropriate statements.

The nurse monitors a 5-year-old child admitted to the hospital for a neuroblastoma for signs/symptoms related to the location of the tumor in the adrenal gland. Which descriptions would the nurse expect to be documented in the child's record specific to this tumor? Select all that apply. 1. Respiratory impairment 2. Anorexia and weight loss 3. Pallor, weakness, irritability 4. Supraorbital ecchymosis and periorbital edema 5. Firm, nontender, irregular mass in the abdomen 6. Urinary frequency or retention from compression on the bladder

5, 6 Rationale: The signs/symptoms of a neuroblastoma depend on the location of the tumor. When the tumor is found on the adrenal gland, the findings will be consistent with a firm, nontender, irregular mass in the abdomen. This will likely cause some degree of urinary frequency or retention from compression on the ureter, or kidney. The remaining descriptions are not specific to the location of the tumor on the adrenal gland.

The nurse observes a mother giving an oral iron supplement to her 6-year-old child with iron deficiency anemia. Which action by the mother indicates the need for further teaching? 1. The mother administered the iron with milk. 2. The mother administered the iron with water. 3. The mother administered the iron with apple juice. 4. The mother administered the iron with orange juice.

1 Rationale: Milk may affect absorption of the iron. Vitamin C increases the absorption of iron by the body. The mother would be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Water will not assist in absorption but will not affect absorption as milk would.

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

3 Rationale: Hyperuricemia, elevated levels of uric acid, is especially common after treatment for leukemias and lymphomas, because the therapy results in massive cell destruction and the release of uric acid. Anemia (low red blood cell count), low platelet levels, and low white blood cell counts are associated with the bone marrow abnormalities that are a part of the leukemias and lymphoma disease process.

When reinforcing teaching about signs/symptoms of ovarian cancer with a community group of women, the nurse emphasizes which as being a most typical manifestation of the disease? 1. Pelvic cramping 2. Sharp abdominal pain 3. Abdominal distention or fullness 4. Postmenopausal vaginal bleeding

3 Rationale: Ovarian cancer is a leading cause of death from gynecological cancers and symptoms are usually vague. A common sign/symptom of ovarian cancer is abdominal distention or fullness. Less common are symptoms of urinary frequency and urgency, and gastrointestinal symptoms such as a change in bowel habits. Pelvic cramping, sharp abdominal pain, or postmenopausal vaginal bleeding are not the most typical signs/symptoms.

Trimethoprim-sulfamethoxazole is prescribed for a client. The nurse would instruct the client to report which symptom if it developed during the course of this medication therapy? 1. Nausea 2. Diarrhea 3. Headache 4. Sore throat

4 Rationale: Clients taking trimethoprim-sulfamethoxazole need to be informed about early signs of blood disorders that can occur from this medication. These include sore throat, fever, and pallor, and the client needs to be instructed to notify the primary health care provider (PHCP) if these symptoms occur. The other options do not require PHCP notification.

The nurse is caring for a client with an internal radiation implant. The nurse needs to observe which principle(s)? Select all that apply. 1. Pregnant women are not allowed into the client's room. 2. Limit the time with the client to 1 hour per 8-hour shift. 3. Wear a lead apron while delivering bedside care to the client. 4. Remove the dosimeter badge when entering the client's room. 5. Individuals younger than 16 years old are allowed in the room if they stay 6 feet away from the client.

1, 3 Rationale: A client receiving treatment for cancer with internal radioactive implant is emitting radioactive beams, and others in the environment must take precautions to avoid injury. Pregnant persons are not allowed in the room. Nurses delivering bedside care must wear a lead apron which will stop the radioactive beams. The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room. Children younger than 16 years old and pregnant women are not allowed in the client's room. These guidelines protect individuals from radiation exposure.

The nurse is reinforcing discharge instructions to a client receiving sulfadiazine. Which would be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. Decrease the dosage when symptoms are improving to prevent an allergic response. 4. If the urine turns dark brown, call the primary health care provider immediately.

2 Rationale: Each dose of sulfadiazine needs to be administered with a full glass of water, and the client needs to maintain a high fluid intake. The medication is more soluble in alkaline urine. The client would not be instructed to taper or discontinue the dose. Some forms of sulfadiazine cause urine to turn dark brown or red. This does not indicate the need to notify the PHCP.

The nurse reinforces instructions to the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement by the parents indicates the need for further teaching? 1. "I need to use proper hand-washing techniques." 2. "I need to take my child's rectal temperature daily." 3. "I need to inspect my child's skin daily for redness." 4. "I need to inspect my child's mouth daily for lesions."

2 Rationale: The risk of injury to the fragile mucous membranes is so great in the child with leukemia that only oral, axillary, or temporal or tympanic temperatures would be taken. Rectal abscesses can easily occur in damaged rectal tissue, so no rectal temperatures would be taken. In addition, oral temperatures need to be avoided if the child has oral ulcers. Options 1, 3, and 4 are appropriate teaching measures.

The nurse caring for a child with aplastic anemia is reviewing the laboratory results and notes a white blood cell (WBC) count of 6000 mm3 and a platelet count of 20,000 mm3. Which nursing intervention would be incorporated into the plan of care? 1. Encourage naps. 2. Encourage a diet high in iron. 3. Encourage quiet play activities. 4. Maintain strict isolation precautions.

3 Rationale: Precautionary measures to prevent bleeding need to be taken when a child has a low platelet count. These include no injections, no rectal temperatures, the use of a soft toothbrush, quiet activities, and abstinence from contact sports or activities that could cause an injury. Strict isolation would be required if the white blood cell (WBC) count was low. Naps and a diet high in iron are unrelated to the risk of bleeding.

Oxybutynin chloride is prescribed for a client with neurogenic bladder. Which sign would indicate a possible toxic effect related to this medication? 1. Pallor 2. Drowsiness 3. Bradycardia 4. Restlessness

4 Rationale: Toxicity (overdose) of this medication produces central nervous system excitation, such as nervousness, restlessness, hallucinations, and irritability. Other signs of toxicity include hypotension or hypertension, confusion, tachycardia, flushed or red face, and signs of respiratory depression. Drowsiness is a frequent side effect of the medication but does not indicate overdose.

The client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. Besides treatment of the lung cancer, the nurse anticipates that which intervention(s) may be prescribed to treat the SIADH? Select all that apply. 1. Increase fluid intake 2. Decreased sodium intake 3. Institute safety measures 4. Frequent monitoring of sodium blood levels 5. Gather data about the neurological status frequently 6. Medication that is antagonistic to antidiuretic hormone (ADH)

3, 4, 5, 6 Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition in which excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is a potential complication associated with cancer, especially small cell lung cancer. SIADH is managed by treating the condition and its cause. The SIADH induces low sodium blood levels and results in altered neurological states, including confusion and unresponsiveness. Treatment of SIADH includes fluid restriction, increased sodium intake, and a medication with a mechanism of action that is antagonistic to antidiuretic hormone (ADH), such as demeclocycline. Sodium blood levels and neurological status are monitored closely and safety interventions need to be instituted. The client would not be treated with an increase in fluid intake or a decrease in the sodium intake.

The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action? 1. Reinsert the implant into the vagina. 2. Call the primary health care provider (PHCP). 3. Pick up the implant with gloved hands and flush it down the toilet. 4. Pick up the implant with long-handled forceps and place into a lead container.

4 Rationale: A lead container and long-handled forceps must be kept in the client's room at all times during internal radiation therapy. Lead is an element that has a high density and high atomic number and is used to shield persons from radiation. If dislodged, the implant must be handled carefully to limit radiation exposure to the client and all persons in the environment. If the implant becomes dislodged, the nurse would pick up the implant with long-handled forceps and place it into the lead container. The radiation safety officer of the institution must be notified. Although the PHCP needs to be notified, this is not the immediate action. The nurse cannot reinsert the implant. A radioactive implant is specifically placed inside the client to kill the cancer while limiting damage to adjacent tissues and organs. Touching the implant with gloves and flushing this down the toilet exposes the nurse and the environment to unsafe levels of radiation.

The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement(s) by the client indicates the need for further teaching? Select all that apply. 1. "I will handle the area gently." 2. "I will wear loose-fitting clothing." 3. "I will avoid the use of deodorants." 4. "I will limit sun exposure to 1 hour daily." 5. "I will apply moisturizer with a cotton tipped applicator for itching."

4, 5 Rationale: The client needs to be instructed to avoid exposure to the sun because of the risk of burns, resulting in altered tissue integrity. No lotions, ointments, deodorants, or medications would be applied to the skin area unless prescribed by the radiologist.

The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines that further teaching is needed if a community member states that which is a sign/symptom of testicular cancer? Select all that apply. 1. Alopecia 2. Back pain 3. Painless testicular swelling 4. A heavy sensation in the scrotum 5. Elevation in prostate-specific antigen (PSA) levels

1, 5 Rationale: Alopecia is not a sign/symptom of testicular cancer. However, it may occur as a result of radiation or chemotherapy. Elevated PSA levels are associated with prostate problems. Testicular swelling without pain and a feeling of heaviness in the scrotum occur with testicular cancer as a result of the tumor growing. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication that may become a chronic problem related to the surgery? 1. Pain at the incisional site 2. Arm edema on the operative side 3. Sanguineous drainage in the Jackson-Pratt drain 4. Complaints of decreased sensation near the operative site

2 Rationale: Clients who undergo mastectomy for breast cancer, especially those with axillary node resection, may develop chronic lymphedema or excessive swelling in the arm and hand. Lymphedema is a complication that may develop immediately after mastectomy, months, or even years after surgery. Slight edema may occur in the immediate postoperative period but would decrease especially if the client rests with the arm supported on a pillow. Women need to avoid injury to the arm on the affected side and not allow venipunctures or blood pressures to be taken in that arm. Pain and numbness near the incision and drainage from the surgical site are expected occurrences after mastectomy and are not indicative of a complication.

The nursing instructor asks a student nurse to describe osteogenic sarcoma. Which statement by the student indicates the need to further research the disease? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "If a weight-bearing limb is affected, then limping is a clinical manifestation." 4. "The symptoms of the disease during the early stage are almost always attributed to normal growing pains.

2 Rationale: Osteogenic sarcoma is the most common bone tumor in children. A clinical manifestation of osteogenic sarcoma is progressive, insidious, intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteogenic sarcoma.

Following kidney transplantation, cyclosporine is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Hemoglobin level of 14.0 g/dL 2. Creatinine level of 0.6 mg/dL 3. Blood urea nitrogen level of 25 mg/dL 4. Fasting blood glucose level of 99 mg/dL

3 Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen level is 10 to 20 mg/dL. The normal creatinine level for a male is 0.6 to 1.2 mg/dL and for a female 0.5 to 1.1 mg/dL. Cyclosporine can lower complete blood cell count levels. A normal hemoglobin is Male: 14 to 18 g/dL; Female: 12 to 16 g/dL. A normal hemoglobin is not an adverse effect. Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99 mg/dL.

The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action? Select all that apply. 1. Eat a high-protein diet. 2. Avoid exposure to sunlight. 3. Wash the skin with a mild soap, and pat it dry. 4. Apply pressure on the radiated area to prevent bleeding. 5. Avoid standing within 6 feet of persons younger than the age of 18 years.

4, 5 Rationale: The client would avoid pressure on the radiated area and wear loose-fitting clothing to prevent a disruption in the skin integrity. A client receiving external radiation is not radioactive and does not need to avoid other persons, including young people. A diet high in protein assists in the healing process. Avoiding sunlight and washing the skin with gentle soap and patting dry will assist with preventing skin disruption.

A 4-year-old child is hospitalized with a suspected diagnosis of Wilms' tumor. The nurse reviews the plan of care and would question which intervention that is written in the plan? 1. Palpate the abdomen for a mass. 2. Check the urine for the presence of hematuria. 3. Monitor the blood pressure for the presence of hypertension. 4. Monitor the temperature for the presence of a kidney infection.

1 Rationale: Wilms' tumor is an intraabdominal and kidney tumor. If Wilms' tumor is suspected, the mass would not be palpated. Excessive manipulation can cause seeding of the tumor and thus cause the spread of the cancerous cells. Hematuria, hypertension, and fever are signs and symptoms that are associated with Wilms' tumor.

The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 mm3. On the basis of this laboratory value, the nurse would perform which intervention(s)? Select all that apply. 1. Monitor stools for occult blood. 2. Keep away from persons who have colds or feel ill. 3. Instruct the client not to bend over at the waist or lift. 4. Floss teeth and rinse mouth with mouthwash after every meal. 5. Instruct the client to blow nose very gently without blocking either nostril.

1, 3, 5 Rationale: Platelets or thrombocytes are necessary for a client to clot. A high risk of hemorrhage exists when the platelet count decreases to less than 20,000 mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000 mm3. The client may be treated with medications or platelet or blood transfusions to improve the platelet count. The nurse needs to monitor the client's stools for blood, both obvious and occult. The client would be very gentle if blowing the nose and not cause any pressure to build up in the head. The client would not bend over at the waist because this action would increase the pressure within the head and increase the risk for an intracerebral bleed. Clients with decreased immunity, which is not the focus of the question, need to avoid ill persons. The client would not floss the teeth and only use a soft toothbrush to avoid bleeding in the mouth.

A sulfonamide is prescribed for a client with a urinary tract infection. During review of the client's record, the nurse notes that the client is taking warfarin sodium daily. Which prescription would the nurse anticipate for this client? 1. Discontinuation of warfarin sodium 2. A decrease in the warfarin sodium dosage 3. An increase in the warfarin sodium dosage 4. A decrease in the usual dose of the sulfonamide

2 Rationale: Sulfonamides can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics such as tolbutamide. When an oral anticoagulant is combined with a sulfonamide, a decrease in the anticoagulant dosage may be needed.

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a suprapubic prostatectomy. The nurse would reinforce which discharge instruction(s)? Select all that apply. 1. Avoid driving a car for 1 week. 2. Restrict fluid intake to prevent incontinence. 3. Take the prescribed stool softener every day. 4. Avoid lifting objects heavier than 20 pounds for 6 weeks. 5. Inspect the incision on the scrotum every day for any redness. 6. Notify the primary health care provider (PHCP) if small blood clots are noticed during urination.

3, 4 Rationale: A suprapubic approach involves a lower abdominal incision to remove the prostate to treat prostate cancer. The nurse will reinforce instructions about the incision activity, medications, and when to contact the urologist. The client would take the prescribed stool softener because constipation will lead to straining and cause pain and tension on the surgical site. The client needs to avoid lifting more than 20 pounds for 6 weeks to avoid tension on the surgical site. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A daily fluid intake of 2 to 2.5 L/day (unless contraindicated) would be maintained to limit clot formation and prevent infection. The incision is not on the scrotum but in the lower abdominal area. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery and do not need to be reported.