NURS 4345 Critical Care Comprehensive Exam 1 Questions & Answers

Critical Care Comprehensive Exam 1 Questions & Answers 1. A client with asthma receives a prescription for high blood pressure during a clinic visit. Which prescription should the nurse anticipate the client to receive that is least likely to exacerbate asthma? A. Carteolol (Ocupress). B. Propranolol hydrochloride (Inderal). C. Pindolol (Visken). D. Metoprolol tartrate (Lopressor). Correct The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2 blocking agent which is also cardioselective and less likely to cause bronchoconstriction. Pindolol (A) carteolol (B) is a beta blocking agent and an effective antihypertensive agent used in managing angina, it can increase a client's risk for bronchoconstriction due to its nonselective beta blocker action. Propranolol (D) also blocks the beta2 receptors in the lungs, causing bronchoconstriction, and is not indicated in clients with asthma and other obstructive pulmonary disorders. 2. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide? A. Obtain another antihypertensive prescription to avoid withdrawal symptoms. B. Stop the medication and keep an accurate record of blood pressure. C. Report any uncomfortable symptoms after stopping the medication. D. Ask the healthcare provider about tapering the drug dose over the next week. Correct Although the healthcare provider discontinued the propranolol, measures to prevent rebound cardiac excitation, such as progressively reducing the dose over one to two weeks (C), should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias. Abrupt cessation (A and B) of the beta-blocking agent may precipitate tachycardia and rebound hypertension, so gradual weaning should be recommended. (D) is not indicated. 3. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional assessment should the nurse make? A. Has the client experienced constipation recently? B. Did the client miss any doses of the medication? C. How long has the client been taking the medication? Correct D. Does the client use any tobacco products? Drowsiness can occur in the early weeks of treatment with clonidine and with continued use becomes less intense, so the length of time the client has been on the medication (A) provides 4.ID: 0 The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for a cholecystectomy. The client asks the nurse to explain the reason for the prescribed medication. What response is best for the nurse to provide? A. Provide a more rapid induction of anesthesia. B. Induce relaxation before induction of anesthesia. C. Decrease the risk of bradycardia during surgery. Correct D. Minimize the amount of analgesia needed postoperatively. Atropine may be prescribed preoperatively to increase the automaticity of the sinoatrial node and prevent a dangerous reduction in heart rate (B) during surgical anesthesia. (A, C and D) do not address the therapeutic action of atropine use perioperatively. 5.ID: 6 An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitant medication should the nurse question that poses a potential development of urinary retention in this geriatric client? A. Antacids. B. Tricyclic antidepressants. Correct C. Nonsteroidal antiinflammatory agents. D. Insulin. Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can exacerbate urinary retention associated with opioids in the older client. Although tricyclic antidepressants and antihistamines with opioids can exacerbate urinary retention, the concurrent use of (A and B) with opioids do not. Nonsteroidal antiinflammatory agents (D) can increase the risk for bleeding, but do not increase urinary retention with opioids (D). 6.ID: 9 A client with osteoarthritis is given a new prescription for a nonsteroidal antiinflammatory drug (NSAID). The client asks the nurse, "How is this medication different from the acetaminophen I have been taking?" Which information about the therapeutic action of NSAIDs should the nurse provide? A. Are less expensive. B. Provide antiinflammatory response. Correct C. Increase hepatotoxic side effects. D. Cause gastrointestinal bleeding. Nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory properties (B), which relieves pain associated with osteoarthritis and differs from acetaminophen, a non-narcotic analgesic and antipyretic. (A) does not teach the client about the medication's actions. Although NSAIDs are food in the stomach to manage this as an expected side effect should be included, but this does not answer the client's question. Acetaminophen is potentially hepatotoxic (D), not NSAIDs. 7.ID: 2 A client with cancer has a history of alcohol abuse and is taking acetaminophen (Tylenol) for pain. Which organ function is most important for the nurse to monitor? A. Cardiorespiratory. B. Liver. Correct C. Sensory. D. Kidney. Acetaminophen and alcohol are both metabolized in the liver. This places the client at risk for hepatotoxicity, so monitoring liver (A) function is the most important assessment because the combination of acetaminophen and alcohol, even in moderate amounts, can cause potentially fatal (NSAIDs), are more likely to promote adverse renal effects (B). Acetaminophen does not place the client at risk for toxic reactions related to (C or D). 8.ID: 0 The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to administering a scheduled dose of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement? A. Give intravenous (IV) calcium gluconate. B. Withhold the drug and notify the healthcare provider. C. Administer the dose as prescribed. Correct D. Recheck the vital signs in 30 minutes and then administer the dose. Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular (AV) nodal conduction, which slows the ventricular rate, and is used to treat atrial flutter, so (A) should be implemented, based on the client's heart rate and blood pressure. (B and C) are not indicated. (D) delays the administration of the scheduled dose. 9.ID: 3 A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza. Which categories of illness should the nurse develop goals for the client's plan of care? A. One chronic and one acute illness. Correct B. Two acute illnesses. C. One acute and one infectious illness. D. Two chronic illnesses. The plan of care should include goals that are specific for chronic and acute illnesses. Adult-onset diabetes is a life-long chronic disease, whereas influenza is an acute illness with a short term duration (C). (A, B, and D) do not include the correct duration categories for this situation. 10.ID: 4 Following an emergency Cesarean delivery, the nurse encourages the new mother to breastfeed her newborn. The client asks why she should breastfeed now. Which information should the nurse provide? A. Stimulate contraction of the uterus. Correct B. Initiate the lactation process. C. Facilitate maternal-infant bonding. D. Prevent neonatal hypoglycemia. When the infant suckles at the breast, oxytocin is released by the posterior pituitary to stimulates the "letdown" reflex, which causes the release of colostrum, and contracts the uterus (C) to prevent uterine hemorrhage. (A and B) do not support the client's need in the immediate period after the emergency delivery. Although maternal-newborn bonding (D) is facilitated by early breastfeeding, the priority is uterine contraction stimulation. 11.ID: 4 Which intervention should the nurse include in the plan of care for a female client with severe postpartum depression who is admitted to the inpatient psychiatric unit? A. Restrict visitors who irritate the client. B. Full rooming-in for the infant and mother. C. Supervised and guided visits with infant. Correct D. Daily visits with her significant other. Structured visits (C) provide an opportunity for the mother and infant to bond and should be facilitated and encouraged according to the client's pace of progress. (A) is unrealistic and may not be safe for the baby or the client. (B) is an unrealistic expectation. Although daily visits may provide support, the significant other may not be able to be there every day (D) based on other family responsibilities. 12.ID: 5 A 16-year-old male client is admitted to the hospital after falling off a bike and sustaining a fractured bone. The healthcare provider explains the surgery needed to immobilize the fracture. Which action should be implemented to obtain a valid informed consent? A. Obtain the permission of the custodial parent for the surgery. Correct B. Notify the non-custodial parent to also sign a consent form. C. Instruct the client sign the consent before giving medications. D. Obtain the signature of the client’s stepfather for the surgery. The client is a minor and cannot legally sign his own consent unless he is an emancipated minor, so the consent should be obtained from the guardian for this client, which is the custodial parent (B). (A) adopted by the stepparent (C). The non-custodial parent does not need to co-sign this form (D). 13.ID: 8 During a client assessment, the client says, "I can't walk very well." Which action should the nurse implement first? A. Predict the likelihood of the outcome. B. Consider alternatives. C. Choose the most successful approach. D. Identify the problem. Correct The sequential steps in problem-solving are to first identify the problem (B), then consider alternatives (C), consider outcomes of the alternatives (D), predict the likelihood of the outcomes occurring, and choose the alternative with the best chance of success (A). 14.ID: 2 The nurse identifies a client's needs and formulates the nursing problem of, "Imbalanced nutrition: less than body requirements, related to mental impairment and decreased intake, as evidenced by increasing confusion and weight loss of more than 30 pounds over the last 6 months." Which short- term goal is best for this client? A. Verbalize understanding of plan and of intention to eat meals. B. Eat 50% of six small meals each day by the end of one week. Correct C. Meals prepared during hospitalization will be fed by the nurse. D. Demonstrate progressive weight gain toward the ideal weight. Short-term goals should be realistic and attainable and should have a timeline of 7 to 10 days before discharge. (A) meets those criteria. (B) is nurse-oriented. (C) may be beyond the capabilities of a confused client. (D) is a long-term goal. 15.ID: 9 A male client is angry and is leaving the hospital against medical advice (AMA). The client demands to take his chart with him and states the chart is "his" and he doesn' t want any more contact with the hospital. How should the nurse respond? A. This hospital does not need to keep it if you are leaving and not returning here. B. Because you are leaving against medical advice, you may not have your chart. C. The information in your chart is confidential and cannot leave this facility legally. D. The chart is the property of the hospital but I will see that a copy is made for you. Correct The chart is the property of the facility, but the client has a legal right to the information in it, even if he is leaving AMA, so a copy of the record (D) should be provided. The client does not lose his legal rights to his medical record if he leaves AMA (A). The medical record is confidential, but the hospital protects the client's privacy by not allowing unauthorized access to the record, so the hospital may provide the client with a copy (B). The hospital must maintain records of the care provided and should not release the original record (C). 16.ID: 6 The nurse manager is assisting a nurse with improving organizational skills and time management. Which nursing activity is the priority in pre-planning a schedule for selected nursing activities in the daily assignment? A. Tracheostomy tube suctioning. B. Medication administration. Correct C. Colostomy care instruction. D. Client personal hygiene. In developing organizational skills, medication administration is based on a prescribed schedule that activities in a daily assignment. Although suctioning a client's tracheostomy takes precedence in providing care, the client's PRN need is less amenable to a preselected schedule. (B and C) can be scheduled around time-sensitive delivery of care. 17.ID: 0 What nursing delivery of care provides the nurse to plan and direct care of a group of clients over a 24-hour period? A. Case management. B. Team nursing. C. Primary nursing. Correct D. Functional nursing. Primary nursing (B) is a model of delivery of care where a nurse is accountable for planning care for clients around the clock. Functional nursing (D) is a care delivery model that provides client care by assignment of functions or tasks. Team nursing (A) is a care delivery model where assignments to a group of clients are provided by a mixed-staff team. Case management (C) is the delivery of care that uses a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs and promote quality cost-effective outcomes. 18.ID: 0 Two unlicensed assistive personnel (UAP) are arguing on the unit about who deserves to take a break first. What is the most important basic guideline that the nurse should follow in resolving the conflict? A. Require the UAPs to reach a compromise. B. Weigh the consequences of each possible solution. C. Encourage the two to view the humor of the conflict. D. Deal with issues and not personalities. Correct Dealing with the issues which are concrete, not personalities (A) which include emotional reactions, conflict when diverse opinions are expressed emotionally. 19.ID: 1 The nurse is caring for a client who is unable to void. The plan of care establishes an objective for the client to ingest at least 1000 mL of fluid between 7:00 am and 3:30 pm. Which client response should the nurse document that indicates a successful outcome? A. Demonstrates adequate fluid intake and output. B. Verbalizes abdominal comfort without pressure. C. Drinks 240 mL of fluid five times during the shift. Correct D. Voids at least 1000 mL between 7 am and 3 pm. The nurse should evaluate the client's outcome by observing the client's performance of each expected behavior, so drinking 240 mL of fluid five or six times during the shift (D) indicates a fluid period. (A) uses the term "adequate," which is not quantified. (B) is not the objective, which establishes an intake of at least 1000 mL. (C) is not an evaluation of the specific fluid intake. 20.ID: 3 The nurse plans a teaching session with a client but postpones the planned session based on which nursing problem? A. Knowledge deficit regarding impending surgery. B. Ineffective management of treatment regimen. C. Activity intolerance related to postoperative pain. Correct D. Noncompliance with prescribed exercise plan. Pain, fatigue, or anxiety can interfere with the ability to pay attention and participate in learning, so the nursing diagnosis in (A) indicates a need to postpone teaching. (B, C, and D) indicate a need for 21.ID: 6 A client who has active tuberculosis (TB) is admitted to the medical unit. What action is most important for the nurse to implement? A. Fit the client with a respirator mask. B. Assign the client to a negative air-flow room. Correct C. Don a clean gown for client care. D. Place an isolation cart in the hallway. Active tuberculosis requires implementation of airborne precautions, so the client should be assigned to a negative pressure air-flow room (D). Although (A and C) should be implemented for clients in isolation with contact precautions, it is most important that air flow from the room is minimized when the client has TB. (B) should be implemented when the client leaves the isolation environment. 22.ID: 5 A client is receiving atenolol (Tenormin) 25 mg PO after a myocardial infarction. The nurse determines the client's apical pulse is 65 beats per minute. What action should the nurse implement next? A. Measure the blood pressure. B. Reassess the apical pulse. C. Notify the healthcare provider. D. Administer the medication. Correct Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to reduce the heart rate, so the medication should be administered (C) because the client's apical pulse is greater than 60. (A, B, and D) are not indicated at this time. 23.ID: 5 The nurse is assessing a client and identifies a bruit over the thyroid. This finding is consistent with which interpretation? A. Hypothyroidism. B. Thyroid cyst. C. Thyroid cancer. D. Hyperthyroidism. Correct Hyperthyroidism (D) is an enlargement of the thyroid gland, often referred to as a goiter, and a bruit may be auscultated over the goiter due to an increase in glandular vascularity which increases as the thyroid gland becomes hyperactive. A bruit is not common with (A, B, and C). 24.ID: 0 A 6-year-old child is alert but quiet when brought to the emergency center with periorbital ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and continues to assess the child for additional manifestations of a basilar skull fracture. What assessment finding would be consistent with a basilar skull fracture? A. Hematemesis and abdominal distention. B. Asymmetry of the face and eye movements. C. Rhinorrhoea or otorrhoea with Halo sign. Correct D. Abnormal position and movement of the arm. Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear over the mastoid process) are both signs of a basilar skull fracture, so the nurse should assess for possible meningeal tears that manifest as a Halo sign with CSF leakage from the ears or nose (D). (A) is consistent with orbital fractures. (B) occurs with wrenching traumas of the shoulder or arm fractures. (C) occurs with blunt abdominal injuries. 25.ID: 5 The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid retraction, and a staring expression. These findings are consistent with which disorder? A. Grave's disease. Correct B. Multiple sclerosis. C. Addison's disease. D. Cushing syndrome. This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease (A), which is an autoimmune condition affecting the thyroid. (B, C, and D) are not associated with these symptoms. 26.ID: 6 The nurse is assessing an older client and determines that the client's left upper eyelid droops, covering more of the iris than the right eyelid. Which description should the nurse use to document this finding? A. A nystagmus on the left. B. Exophthalmos on the right. C. Ptosis on the left eyelid. Correct D. Astigmatism on the right. Ptosis is the term to describe an eyelid droop that covers a large portion of the iris (A), which may result from oculomotor nerve or eyelid muscle disorder. (B) is characterized by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye, causing decreased visual acuity. (D) is a term used to describe a protrusion of the eyeballs that occurs with hyperthyroidism. 27.ID: 6 The nurse is assessing a child's weight and height during a clinic visit prior to starting school. The nurse plots the child's weight on the growth chart and notes that the child's weight is in the 95th percentile for the child's height. What action should the nurse take? A. Question the type and quantity of foods eaten in a typical day. Correct B. Encourage giving two additional snacks each day to the child. C. Recommend a daily intake of at least four glasses of whole milk. D. Assess for signs of poor nutrition, such as a pale appearance. The child is overweight for height, so assessment of the child's daily diet (C) should be determined. The child does not need (A or B), both of which will increase the child's weight. Poor nutrition (D) is commonly seen in underweight children, not overweight. 28.ID: 2 A child is receiving maintainance intravenous (IV) fluids at the rate of 1000 mL for the first 10 kg of body weight, plus 50 mL/kg per day for each kilogram between 10 and 20. How many milliliters per hour should the nurse program the infusion pump for a child who weighs 19.5 kg? (Enter numeric value only. If rounding is required, round to the nearest whole number.) A. 24 B. 61 Correct C. 73 D. 58 The formula for calculating daily fluid requirements is: 0 to 10 kg, 100 mL/kg per day; or 10 to 20 kg, 1000 mL for the first 10 kg of body weight plus 50 mL/kg per day for each kilogram between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24. 19.5 kg x 50 mL/kg = 475 mL + 1000 mL = 1475 mL / 24 hours = 61 mL/hour 29.ID: 0 The nurse obtains the pulse rate of 89 beats/minute for an infant before administering digoxin (Lanoxin). Which action should the nurse take? A. Withhold the medication and contact the healthcare provider. Correct B. Give the medication dosage as scheduled. C. Assess respiratory rate for one minute next. D. Wait 30 minutes and give half of the dosage of medication. Bradycardia is an early sign of digoxin toxicity, so if the infant's pulse rate is less than 100 beats/minute, digoxin should be withheld and the healthcare provider should be notified (D). Assessing the respiratory rate (A) is not indicated before administering Lanoxin. (B and C) place the 30.ID: 7 The nurse is developing a teaching plan for an adolescent with a Milwaukee brace. Which instruction should the nurse include? A. Wear the brace over a T-shirt 23 hours per day. Correct B. Dress with the brace over regular clothing. C. Shower with the brace directly against the skin. D. Remove the brace just before going to bed. Idiopathic scoliosis is an abnormal lateral curvature of the spine in adolescent females. Early treatment uses a Milwaukee brace that places pressure against the lateral spinal curvature, under the neck, and against the iliac crest, so it should be worn for 23 hours per day over a T-shirt (D) which reduces friction and chafing of the skin. (A, B, and C) reduce the effectiveness of the brace. 31.ID: 4 A 9-year-old is hospitalized for neutropenia and is placed in reverse isolation. The child asks the nurse, "Why do you have to wear a gown and mask when you are in my room?" How should the nurse respond? A. “To protect you because you can get an infection very easily.” Correct B. "Your condition could be spread to staff and other clients in the hospital.” C. “There are many forms of bacteria and germs in the hospital.” D. “After taking medication for 24 hours a gown and mask won't be needed.” Reverse isolation precaution implement measures to protect the client from exposure to microorganisms from others (B). Although microbes are prevalent in all environments, (A) does not adequately answer the child's question. Reverse isolation should be implemented until the client's white blood cell increases (C). Neutropenia in this child does not place others (D) at risk for infection. 32.ID: 0 The nurse is giving discharge instructions to the parents of a newborn with a prescription for home phototherapy. Which statement by a parent indicates understanding of the phototherapy? A. “I should leave the baby under the light all of the time.” B. “I should dress the baby in light clothing when the baby is under the light.” C. “I need to change the baby’s position every four hours.” D. “I will keep the baby’s eyes covered when the baby is under the light.”Correct Neonatal jaundice is related to subcutaneous deposition of fat-soluble (indirect) bilirubin, which is converted to a water-soluble form when the skin is exposed to an ultraviolet light, so the infant's eyes should be protected (C) by closing the eyes and placing patches over them before placing the baby under the phototherapy light source. The baby's position should be changed about every two hours, not (A), so that the light reaches all areas of the body to promote conversion to a water-soluble form of bilirubin, which is excreted in the urine. The infant can be removed from the light for feedings and diaper changes, but should receive phototherapy exposure for 18 hours a day (B). The baby should be naked or dressed in only a diaper to expose as much skin as possible to the light (D). 33.ID: 2 A male client who had abdominal surgery has a nasogastric tube to suction, oxygen per nasal cannula, and complains of dry mouth. Which action should the nurse implement? A. Apply a water soluble lubricant to the lips, oral mucosa and nares.Correct B. Put petroleum jelly on the lips and around the nasogastric tube. C. Offer the client ice chips and instruct client to spit out the water. D. Allow the client to drink water and record on the I and O record. To ease the client's discomfort, a water soluble lubricant to the lips and nares assists to keep the mucous membranes moist (D). (A) is a petroleum-based product and should not be used because it 34.ID: 4 The nurse is assessing the laboratory results for a client who is admitted with renal failure and osteodystrophy. Which findings are consistent with this client's clinical picture? A. Hemoglobin of 10 g and hypophosphatemia. B. Cloudy, amber urine with sediment, specific gravity of 1.040. C. Serum potassium of 5.5 mEq and total calcium of 6 mg/dl. Correct D. Blood urea nitrogen 40 m and creatinine 1.0. In renal failure, normal serum electrolyte balance is altered because the kidneys fail to activate vitamin D, calcium absorption is impaired, and serum calcium decreases, which stimulates the release of PTH causing resorption of calcium and phosphate from the bone. A decreased tubular excretion and a decreased glomerular filtration rate results in hypocalcemia, hyperphosphatemia, and hyperkalemia (C). (A) is reflective of a non-renal cause, such as dehydration or liver pathology. (B) is more indicative of infection. Renal failure causes anemia and hyperphosphatemia, not (D). 35.ID: 0 Which information should the nurse give a client with chronic kidney disease (CKD)? A. Obtain monthly B12 injections. B. Restrict calcium-rich foods. C. Avoid salt substitutes. Correct D. Increase daily intake of fiber. A client with CKD should restrict sodium and potassium dietary intake, and salt substitutes usually contain potassium, so (C) should be taught. Hypocalcemia is a complication of CKD and calcium supplements are often needed, not (A). Anemia related to CKD is treated with iron, folic acid, and erythropoietin, not (B). Although (D) is a common dietary recommendation, it not an essential part of client teaching for CKD. 36.ID: 6 A nurse is answering questions about breast cancer at a hospital-sponsored community health fair. A woman asks the nurse to explain the use of tamoxifen (Nolvadex). Which response should the nurse provide? A. Part of a combination of chemotherapeutic agents used to treat tumors. B. An used to reduce the risk of breast cancer for all women. C. Low doses of tamoxifen prevent menopausal hot flashes. D. This anti-estrogen drug inhibits malignancy growth. Correct Tamoxifen (Nolvadex) is used in postmenopausal women with breast cancer to prevent and treat recurrent cancer and inhibit the growth-stimulating effects (C) of estrogen by blocking estrogen receptor sites on malignant cells. A side effect of tamoxifen is hot flashes (A), which is related to the decreased estrogen. Tamoxifen is used for women with estrogen receptor-positive breast cancer, not all women (B), and is classified as a hormonal agent, not (D), used to suppress malignant cell growth. 37.ID: 8 A 56-year-old female client is receiving intracavitary radiation via a radium implant. Which nurse should be assigned to care for this client? A. The nurse who is caring for another client receiving intracavitary radiation. B. A nurse with Marfan's syndrome who is postmenopausal. Correct C. A nurse with oncology experience who may be pregnant. D. The nurse who is caring for another client who has Clostridium difficile. A client receiving intracavity radiation poses a radiation hazard as long as the intracavity radiation source is in place. A nurse's ability to care of this client is not affected by Marfan's syndrome (B), which is a hereditary disorder of connective tissues, bones, muscles, ligaments and skeletal structures. The goal is to limit any one staff member's exposure to the calculated time span based on the half-life of radium, such as the number of minutes at the bedside per day, so (A) should not be assigned. (C) should not be exposed to the radiation due to the possible effect on the fetus. A radiation exposure decreases the immune response in the client who should not be exposed to the potential inadvertent transmission of an infectious organism (D). 38.ID: 1 Which information should the nurse provide a client who has undergone cryosurgery for Stage 1A cervical cancer? A. Use condoms for sexual intercourse during the next week. B. Notify the healthcare provider if heavy vaginal discharge occurs. C. Use a sanitary napkin instead of a tampon. Correct D. Flat subclinical mucosal lesions are a common harmLess side effect. Clients should avoid the use of tampons for 3 to 6 weeks (D) after the procedure to reduce the risk of Sexual intercourse should be avoided for up to 6 weeks, so (B) is inaccurate. (C) is not a side effect of the procedure but may indicate human papillomavirus or a cancerous lesion and should be reported. 39.ID: 5 Which nurse follows a client from admission through discharge or resolution of illness and coordinates the client's care between healthcare providers? A. Case manager. Correct B. Nurse-manager. C. Discharge manager. D. Quality manager. The role of the case manager (A) is to assist the continuum of care for the client, and coordinate the plan of care, evaluate client needs, and collaborate with the interdisciplinary healthcare team to ensure that goals are met, quality is maintained, and progress toward discharge is made. (B) focuses on staffing and assigning work on client units. (C) reviews research and assesses opportunities for process improvement, implement changes, measure outcomes, and start the discharge but would not be involved with client admission activities. 40.ID: 6 The nurse is preparing a client for a scheduled surgical procedure. What client statement should the nurse report to the healthcare provider? A. Expresses fear about the surgical procedure. B. Reports a history of hives after eating shellfish. C. States has a history of post-operative nausea. D. Recalls drinking a glass of juice after midnight. Correct The risk of aspiration while under general anesthesia is increased when the stomach is not empty prior to a surgical procedure, so the client's intake of juice (B) after midnight should be reported the healthcare provider. Preoperative fear and anxiety (A) are common and should be further explored by the nurse. (C) should be communicated using allergy identification tags on the client's records and bracelets on the client's wrist. (D) is a common and expected side effect of perioperative medications. 41.ID: 6 The parents of a 14-year-old boy express concern about their son's behavior, which ranges from clean-cut and personable to "grungy" and sullen. They have tried talking with him and disciplining him, but he continues to demonstrate confusing behaviors. Which information is best for the nurse to provide? A. Rebelliousness requires consequences to prevent socially deviant behavior. B. The parents should consider hospitalization to prevent self injury. C. Adolescents who dem