A client receiving ferrous sulfate (Fer-Iron) therapy to treat an iron deficiency reports taking an antacid frequently to relieve heart burn. Which nursing instruction should the nurse provide?

Correct Answer: B

Rationale: The correct answer is B: "Take ferrous sulfate and the antacid at least 2 hours apart." Rationale: 1. Iron absorption is decreased in the presence of antacids due to decreased gastric acidity. 2. Antacids can bind to iron and reduce its absorption. 3. Taking them 2 hours apart allows for optimal iron absorption without interference from the antacid. 4. Taking them together (choice A) would decrease iron absorption. 5. Avoiding antacids altogether (choice C) may not be necessary if spaced apart appropriately. 6. Taking them 1 hour apart (choice D) may still lead to decreased iron absorption due to antacid interference.

Correct Answer: B

Rationale: The correct answer is B: Cerebral edema. Hypernatremia is an elevated sodium level in the blood, which can lead to osmotic shifts causing water to move out of cells, including brain cells. This can result in cerebral edema, potentially leading to neurological complications. Incorrect choices: A: Red blood cell crenation - This occurs in hypertonic solutions, not hypernatremia. C: Red blood cell hydrolysis - Hypernatremia doesn't directly cause red blood cell hydrolysis. D: Renal shutdown - Hypernatremia can stress the kidneys, but it doesn't typically lead to renal shutdown.

Correct Answer: A

Rationale: The correct answer is A: Raccoon eyes. Basilar skull fracture can result in periorbital bruising, known as raccoon eyes, due to blood pooling in the soft tissues around the eyes. This occurs because the fracture involves the base of the skull near the orbits. Choice B: Amnesia is not a typical symptom of basilar skull fracture. Amnesia may occur in head injuries but is not specific to basilar skull fractures. Choice C: Halo sign is a term used to describe a ring of clear fluid surrounding a blood spot, typically seen in cases of a cerebrospinal fluid leak from the ear or nose, not specific to basilar skull fractures. Choice D: Paresthesia, which refers to abnormal sensations like tingling or numbness, is not a common symptom of basilar skull fractures. It is more associated with nerve damage rather than fractures involving the base of the skull.

Correct Answer: A

Rationale: The correct answer is A because testicular cancer is indeed a highly curable type of cancer if detected early through self-examinations. This empowers the client to take control of their health. Choice B is incorrect as testicular cancer is detectable through self-examinations. Choice C is incorrect as testicular cancer is not the number one cause of cancer deaths in males; it is relatively rare. Choice D is incorrect as testicular cancer is more common in younger men, typically between the ages of 15 and 44.

Correct Answer: B

Rationale: The correct answer is B because the inability to move the affected leg post lumbar microdiskectomy could indicate a serious complication like nerve damage or blood clot. This would require immediate medical attention to prevent further complications. Incisional pain (A) is common and can be managed with pain medication. A two-inch area of bleeding on the dressing (C) is concerning but can be managed with proper wound care unless it is excessive. Muscle spasm (D) is also common postoperatively and can be managed with medications or physical therapy.

Correct Answer: B

Rationale: The correct answer is B: Focused assessment. In this scenario, the client's abdominal pain is a known issue, so a focused assessment would be appropriate to gather specific information related to the current complaint. A focused assessment allows the nurse to concentrate on the particular problem at hand, which in this case is the abdominal pain. A: Initial assessment is not applicable as the client has been seen for this issue before. C: Emergency assessment is not necessary as the situation does not indicate an urgent or life-threatening condition. D: Time-lapsed assessment is not suitable because it involves assessing changes over time, which is not the primary concern in this scenario. In summary, a focused assessment is the most appropriate choice as it allows the nurse to address the client's specific complaint efficiently.

Correct Answer: B

Rationale: The correct answer is B: Stage 2 hypertension. The patient's BP readings consistently fall within the range of 160-179 systolic or 100-109 diastolic, which aligns with the criteria for Stage 2 hypertension based on the current guidelines. This classification indicates a higher level of hypertension that requires prompt medical attention and intervention to reduce the risk of complications. Choices A, C, and D are incorrect because they do not correspond to the BP readings provided, falling outside the range for prehypertension, Stage 1 hypertension, and posthypertension.

Correct Answer: B

Rationale: The correct answer is B because encouraging the patient to do leg exercises within the limits of his traction promotes independence by maintaining muscle strength and mobility. This helps prevent muscle atrophy and promotes circulation. Choice A focuses on pain management but does not directly promote independence. Choice C provides assistance but does not actively involve the patient in self-care. Choice D is important for overall care but does not directly promote independence through active patient involvement.

Correct Answer: A

Rationale: The correct answer is A: Vasopressin (Pitressin Synthetic). In diabetes insipidus, there is a deficiency of ADH (antidiuretic hormone), leading to excessive urination and thirst. Vasopressin is a synthetic form of ADH that helps retain water by reducing urine output. Administering vasopressin helps manage the symptoms of diabetes insipidus. B: Regular insulin is used to manage diabetes mellitus, not diabetes insipidus. C: Furosemide is a diuretic used to increase urine output, which would worsen the symptoms of diabetes insipidus. D: 10% dextrose is a form of glucose and is not indicated in the treatment of diabetes insipidus.