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Questions 158

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Question 1 of 5

A 5-year-old child was recently diagnosed as having acute lymphoid leukemia. She is hospitalized for additional tests and to begin a course of chemotherapy designed to induce a remission. She is scheduled to have a bone marrow aspiration tomorrow. She has had a bone marrow test previously and is apprehensive about having another. Which of the following interventions will be most effective in relieving her anxiety?

Correct Answer: A

Rationale: Providing a detailed explanation of the procedure helps reduce anxiety by preparing the child for what to expect, addressing her previous experience.

Question 2 of 5

A 68-year-old client developed acute respiratory distress syndrome while hospitalized for pneumonia. After a respiratory arrest, an endotracheal tube was inserted. Several days later, numerous attempts to wean him from mechanical ventilation were ineffective, and a tracheostomy was created. For the first 24 hours following tracheostomy, it is important to minimize bleeding around the insertion site. The nurse can accomplish this by:

Correct Answer: B

Rationale: The tracheal cuff should not be deflated within the first 24 hours following surgery.
To minimize bleeding, any manipulation, including cuff deflation, should be avoided. Small amounts of crepitus are expected to occur; however, large amounts or expansion of the area of crepitus should be reported to the physician. The tracheostomy site may be changed as often as necessary, but site care should be done with normal saline.

Question 3 of 5

A female client plans to bottle-feed her newborn. Her physician has ordered bromocriptine (Parlodel) to suppress lactation. Which of the following instructions about bromocriptine should be given by the nurse?

Correct Answer: D

Rationale: Bromocriptine inhibits the secretion of prolactin. Hypotension is a side effect of this drug; hypertension is not. Bromocriptine is generally taken for 14 days. The administration of bromocriptine is delayed at least 4 hours postpartum and given only when the client's blood pressure is stable, because it can cause hypotension and syncope.

Question 4 of 5

A client with a history of multiple myeloma is admitted with complaints of bone pain. The nurse should give priority to:

Correct Answer: B

Rationale: Bone pain in multiple myeloma is often due to bone destruction, which can cause hypercalcemia, so monitoring for hypercalcemia is the priority.

Question 5 of 5

A client with a history of a peptic ulcer is being discharged. The nurse should teach the client to:

Correct Answer: A

Rationale: Spicy foods can irritate a peptic ulcer, delaying healing. Small meals, avoiding lying down post-meals, and limiting caffeine are also recommended.

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