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Questions 164

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Question 1 of 5

The nurse is talking with a client with hypertension and hyperlipidemia who is receiving nifedipine and simvastatin. Which of the following statements by the client would require follow-up?

Correct Answer: B

Rationale: Grapefruit juice (
B) inhibits CYP3A4, increasing simvastatin levels and risk of toxicity. Orthostatic precautions (
A), moderate wine (
C), and herbs (
D) are appropriate.

Question 2 of 5

The intensive care nurse is caring for a client who has just been extubated. Which interventions are appropriate at this time?

Correct Answer: B,C,D,E

Rationale: Post-extubation, warmed, humidified oxygen (
B) prevents mucosal drying, ice chips (
C) moisten the mouth, oral sponges (
D) maintain hygiene, and incentive spirometry (E) promotes lung expansion. Oral narcotics (
A) are risky due to potential airway compromise.

Question 3 of 5

The nurse is reinforcing skin care guidelines for a client who is receiving external radiation therapy. Which of the following statements by the client would indicate a correct understanding of the teaching?

Correct Answer: C,D,E

Rationale: Sun protection (
C), gentle washing (
D), and loose clothing (E) are correct for radiation therapy skin care. Ice packs (
A) can damage skin, and baby oil (
B) may irritate or trap radiation.

Question 4 of 5

A 78-year-old client is admitted following a cerebrovascular accident. He cannot move his left arm and leg. Which finding would indicate to the nurse that the client also has homonymous hemianopia?

Correct Answer: B

Rationale: Homonymous hemianopia, a visual field defect from right brain stroke, causes left-sided vision loss, so the client misses the nurse on the left, unlike arm movement, swallowing, or speech issues.

Question 5 of 5

The nurse is to administer a tuberculin skin test. What is the correct procedure?

Correct Answer: C

Rationale: Tuberculin skin tests are given intradermally at a 10-degree angle on the volar forearm to create a wheal, ensuring accurate reading.

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