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Questions 148

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Question 1 of 5

The nurse caring for a client with myasthenia gravis recognizes which of the following as the priority nursing diagnosis?

Correct Answer: C

Rationale: Myasthenia gravis causes muscle weakness, including respiratory muscles, making ineffective airway clearance the priority due to risk of respiratory failure.

Question 2 of 5

Twenty-four hours after an uncomplicated labor and delivery, a client's WBC is 12,000 cu/mm. The elevation in the client's WBC is most likely an indication of:

Correct Answer: A

Rationale: A WBC of 12,000 cu/mm post-delivery is a normal physiological response to the stress of labor and delivery.

Question 3 of 5

The wife of a client with colorectal cancer (CRC) is talking to the nurse about prevention and screening of the disease. Which statement should the nurse make to the wife?

Correct Answer: A

Rationale: A low-fat, high-fiber diet with fruits reduces CRC risk. Screening begins at 45 for average risk, with colonoscopy every 10 years or fecal occult blood test annually.

Question 4 of 5

The orthopedic nurse should be particularly alert for a fat embolus in which of the following clients having the greatest risk for this complication after a fracture?

Correct Answer: C

Rationale: Fat embolism is most common in long bone fractures, especially the femur, and in young adults. A 21-year-old with a femur fracture is at highest risk.

Question 5 of 5

A client with cancer is experiencing a common side effect of chemotherapy administration. Which laboratory assessment finding would cause the most concern?

Correct Answer: C

Rationale: A platelet count of 100,000/mm^3 indicates thrombocytopenia, a common chemotherapy side effect, increasing bleeding risk and requiring close monitoring.

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