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Questions 158

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Question 1 of 5

A 19-year-old client has sustained a C-7 fracture, which resulted in his spinal cord being partially transected. By 2 weeks' postinjury, his neck has been surgically stabilized, and he has been transferred from the intensive care unit. A potential life-threatening complication the nurse monitors the client for is:

Correct Answer: A

Rationale: Autonomic dysreflexia, a life-threatening exaggerated sympathetic response, can occur in spinal cord injuries above T6, causing severe hypertension.

Question 2 of 5

The nurse is teaching about irritable bowel syndrome (IBS). Which of the following would be most important?

Correct Answer: A

Rationale: A balanced diet with adequate fiber (soluble for IBS) helps regulate bowel function and reduce IBS symptoms. High fluid intake with meals may exacerbate symptoms, low-fiber diets can worsen constipation, and limiting fruits/vegetables is not advised.

Question 3 of 5

The client is diagnosed with a urinary tract infection. Which instruction should the nurse include in the discharge teaching?

Correct Answer: B

Rationale: Completing the full course of antibiotics is essential to eradicate the infection and prevent resistance in a urinary tract infection. Fluid intake should increase, sexual activity can resume after treatment, and heating pads may not be advised.

Question 4 of 5

A client with a history of a stroke is being taught to use a cane. The nurse should teach the client to:

Correct Answer: C

Rationale: The cane should be used on the weak side to support the affected leg, improving balance and gait post-stroke. Holding it in the strong hand or advancing with the strong leg is incorrect.

Question 5 of 5

The nurse is caring for a client with leukemia who is receiving the drug doxorubicin (Adriamycin). Which toxic effects of this drug would be reported to the physician immediately?

Correct Answer: A

Rationale: Rales and distended neck veins suggest cardiotoxicity (e.g., heart failure), a serious doxorubicin side effect requiring immediate reporting. Red urine (
B) is expected, nausea/vomiting (
C) are common, and BUN/skin changes (
D) are less urgent.

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