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Questions 158

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Question 1 of 5

The physician has ordered a 24-hour urine collection for a client. Which instruction should the nurse provide?

Correct Answer: A

Rationale: For a 24-hour urine collection, the first void is discarded, and all subsequent urine is collected for exactly 24 hours to ensure accurate measurement of analytes. A single container is used, refrigeration is advised, but separate voids are not needed.

Question 2 of 5

A client receiving Parnate (tranylcypromine) is admitted in a hypertensive crisis. Which food is most likely to produce a hypertensive crisis when taken with the medication?

Correct Answer: D

Rationale: MAOIs like tranylcypromine interact with tyramine-rich foods like aged cheddar cheese, causing hypertensive crisis. Processed, cottage, and cream cheeses have lower tyramine content.

Question 3 of 5

The nurse is teaching a client with a history of hypertension about medication adherence. The nurse should tell the client to:

Correct Answer: A

Rationale: Adherence to antihypertensives is critical in hypertension to maintain blood pressure control and prevent complications.

Question 4 of 5

The nurse is assessing a client with suspected deep vein thrombosis (DVT). Which finding is most indicative?

Correct Answer: B

Rationale: A warm, red, swollen calf is a classic sign of DVT due to clot-related inflammation. Bilateral edema (
A) suggests heart failure, cramping (
C) is nonspecific, and pale/cool foot (
D) indicates arterial occlusion.

Question 5 of 5

During the active phase of rheumatic fever, the nurse teaches parents of a child with acute rheumatic fever to assist in minimizing joint pain and promoting healing by:

Correct Answer: C

Rationale: Any movement of the joint causes severe pain.
Touching or moving the joint causes severe pain. Immobilization in a functional position allows the joint to rest and heal. Pressure from the warm water bottle or pads can cause severe pain or burning of the skin.

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