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Questions 164

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Question 1 of 5

Prior to discharge from the postanesthesia care unit following a vein stripping of the left leg, the nurse should tell the client to:

Correct Answer: B

Rationale: Elevating legs or walking promotes venous return, while avoiding prolonged standing/sitting prevents stasis post-vein stripping. Heat, non-weight bearing, and early bandage removal are not recommended.

Question 2 of 5

The unit secretary notifies the nurse that 4 clients called the nurses' station reporting pain. Which client should the nurse assess first?

Correct Answer: A

Rationale: Shoulder pain radiating down the arm post-amputation suggests a possible cardiac event (e.g., angina), a life-threatening condition requiring immediate assessment. Other pains, while severe, are more likely related to known conditions.

Question 3 of 5

An elderly client has a 17-mm induration after a tuberculin skin test. Based on this result, which statement is most accurate?

Correct Answer: B

Rationale: A 17-mm induration in an elderly client indicates TB infection, as the threshold is ≥10 mm for high-risk groups. It doesn't confirm active disease, which requires further testing (e.g., chest X-ray). False positives are possible but not assumed based on age alone. Isolation isn't required without active disease.

Question 4 of 5

The nurse is monitoring a client who is going through barbiturate withdrawal. Which symptom is of most concern to the nurse?

Correct Answer: D

Rationale: Seizures in barbiturate withdrawal are life-threatening, requiring immediate intervention, unlike nausea, anxiety, or hallucinations.

Question 5 of 5

The nurse is caring for a 2 year-old who is being treated with chelation therapy, calcium disodium edetate, for lead poisoning. The nurse should be alert for which of the following side effects?

Correct Answer: C

Rationale: Nephrotoxicity. Nephrotoxicity is a common side effect of calcium disodium edetate, in addition to lead poisoning in general.

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