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Questions 158

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Question 1 of 5

Which of the following is a late sign associated with oral cancer?

Correct Answer: C

Rationale: Pain is a late sign of oral cancer, often occurring as the tumor invades deeper tissues or nerves. Early signs include ulcers or white/red patches, while warmth and odor are less specific, and flat-edged ulcers are not typical.

Question 2 of 5

The nurse is caring for a client with a history of a fractured humerus who is in a sling. The client complains of numbness. The nurse should:

Correct Answer: C

Rationale: Numbness in a slung humerus suggests neurovascular compromise, requiring immediate physician notification. Ice, elevation, and massage are insufficient or contraindicated.

Question 3 of 5

Which of the following would the nurse expect to find following respiratory assessment of a client with advanced emphysema?

Correct Answer: A

Rationale: Distant breath sounds are characteristic of emphysema due to increased anteroposterior chest diameter, overdistention, and air trapping.

Question 4 of 5

Which action by the healthcare worker indicates a need for further teaching?

Correct Answer: D

Rationale: Wearing gloves to monitor an IV infusion rate is unnecessary unless contact with bodily fluids is anticipated indicating a need for further teaching on standard precautions. The other actions are appropriate safety measures.

Question 5 of 5

A client with schizophrenia is started on Zyprexa (olanzapine). Three weeks later, the client develops severe muscle rigidity and elevated temperature. The nurse should give priority to:

Correct Answer: D

Rationale: Muscle rigidity and fever suggest neuroleptic malignant syndrome (NMS), a life-threatening reaction to olanzapine. Immediate transfer to a medical unit for urgent treatment is critical.

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