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Questions 164

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Question 1 of 5

The nurse is talking with a client who has breast cancer and is receiving tamoxifen. Which of the following statements by the client would require immediate follow-up?

Correct Answer: D

Rationale: Heavy menses while on tamoxifen may indicate endometrial hyperplasia or cancer, a serious side effect requiring immediate evaluation. Hot flashes, vaginal dryness, and decreased libido are common, less urgent side effects.

Question 2 of 5

The nurse is caring for assigned clients. The nurse should first check the client with

Correct Answer: A

Rationale: Severe pain (9/10) in sickle cell disease indicates a possible vaso-occlusive crisis, a medical emergency requiring immediate assessment. Fever, tachycardia, and hyperglycemia are less urgent.

Question 3 of 5

The nurse is planning care for a client who is taking cyclosporin (Neoral). What would be an appropriate nursing diagnosis for this client?

Correct Answer: B

Rationale: Cyclosporin (Neoral) inhibits normal immune responses. Clients receiving cyclosporin are at risk for infection.

Question 4 of 5

The nurse enters the room of a woman who had a vaginal hysterectomy three days ago and finds her crying. What is the best initial approach for the nurse?

Correct Answer: A

Rationale: Asking about her concerns opens therapeutic communication, addressing her emotional needs directly and empathetically.

Question 5 of 5

The nurse is caring for a client who has developed cardiac tamponade. Which finding would the nurse anticipate?

Correct Answer: C

Rationale: Distended neck veins. Cardiac tamponade causes venous congestion, leading to distended neck veins.

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