A client has undergone laryngectomy. The immediate nursing priority would be:

Solution

Keep trachea free of secretions

Option A: Patent airway is the most priority; therefore removal of secretions is necessary.

A male client with tuberculosis asks Nurse Brian how long the chemotherapy must be continued. Nurse Brian’s accurate reply would be:

Solution

6 to 12 months

Option B: Tubercle bacillus is a drug-resistant organism and takes a long time to be eradicated. Usually a combination of three drugs is used for minimum of 6 months and at least six months beyond culture conversion.

Nurse Anna is aware that early adaptation of client with renal carcinoma is:

Solution

intermittent hematuria

Option D: Intermittent pain is the classic sign of renal carcinoma. It is primarily due to capillary erosion by the cancerous growth.

An 83-year-old woman has several ecchymotic areas on her right arm. The bruises are probably caused by:

Solution

increased capillary fragility and permeability

Option A: Aging process involves increased capillary fragility and permeability. Older adults have a decreased amount of subcutaneous fat and cause an increased incidence of bruise-like lesions caused by collection of extravascular blood in loosely structured dermis.

Nurse Faith should recognize that fluid shift in an client with burn injury results from increase in the:

Solution

Permeability of capillary walls

Option C: In burn, the capillaries and small vessels dilate, and cell damage causes the release of a histamine-like substance. The substance causes the capillary walls to become more permeable and significant quantities of fluid are lost.

Which of the following complications associated with tracheostomy tube?

Solution

Damage to laryngeal nerves

Option D: Tracheostomy tube has several potential complications including bleeding, infection and laryngeal nerve damage.

Nurse Katrina should anticipate that all of the following drugs may be used in the attempt to control the symptoms of Ménière’s Disease except:

Solution

Glucocorticoids

Option D: Glucocorticoids play no significant role in disease treatment.

Nurse Jon assesses vital signs on a client undergone epidural anesthesia. Which of the following would the nurse assess next?

Solution

Bladder distension

Option B: The last area to return sensation is in the perineal area, and the nurse in charge should monitor the client for distended bladder.

Among the following clients, which among them is high risk for potential hazards from the surgical experience?

Solution

67-year-old client

Option A: A 67-year-old client is greater risk because the older adult client is more likely to have a less-effective immune system.

Atropine sulfate (Atropine) is indicated in all but one of the following client?

Solution

A client with glaucoma

Option C: Atropine sulfate is contraindicated with glaucoma patients because it increases intraocular pressure.

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