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Questions 164

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Question 1 of 5

A child and his family were exposed to Mycobacterium tuberculosis about 2 months ago, to confirm the presence or absence of an infection, it is most important for all family members to have a

Correct Answer: D

Rationale: PPD intradermal test. The administration of the PPD intradermal test determines the presence of the infection with the Mycobacterium tuberculosis organism. It is effective at 3 to 6 weeks after the initial infection.

Question 2 of 5

A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the post-operative period?

Correct Answer: B

Rationale: A goiter is hyperplasia of the thyroid gland. Removal of a goiter can result in laryngeal spasms and airway occlusion. The other answers are lesser in priority.

Question 3 of 5

A nursing advocate is one who:

Correct Answer: B

Rationale: Nurse advocates work with clients to provide information and assistance is decision-making. The decisions and care that occur from these decisions are based on the right of the client to self-determination.

Question 4 of 5

Which of the following nursing interventions is essential when caring for a client who is receiving Cyclophosphamide (Cytoxin)?

Correct Answer: B

Rationale: Cyclophosphamide can cause hemorrhagic cystitis; monitoring urine output is critical to detect blood in the urine and ensure adequate hydration.

Question 5 of 5

The nurse is preparing to administer an anticholinergic medication to a client with irritable bowel syndrome. Which of the following findings would require follow-up prior to administering the medication?

Correct Answer: A

Rationale: Anticholinergics can worsen urinary retention, so 650 mL post-void residual (
A) requires follow-up. Macular degeneration (
B), loose stools (
C), and fatigue (
D) are not contraindications.

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