A nurse cares for a female client who has a family history of cystic fibrosis. The client asks, Will my children have cystic fibrosis? How should the nurse respond?

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Question 1 of 5

A nurse cares for a female client who has a family history of cystic fibrosis. The client asks, Will my children have cystic fibrosis? How should the nurse respond?

Correct Answer: C

Rationale: Rationale: C is correct because it encourages genetic testing for both the client and their partner to assess the risk of passing on the cystic fibrosis gene. This approach provides the necessary information for informed decision-making regarding family planning. A is incorrect because being a carrier does not guarantee that the children will also be carriers. B is incorrect as it inaccurately states that if the client is a carrier, their children will have the disorder. D is incorrect because it oversimplifies the etiology of cystic fibrosis and suggests dietary adjustments as a solution, which is not effective in managing the genetic condition.

Question 2 of 5

A nurse assesses a client who has a history of heart failure. Which question should the nurse ask to assess the extent of the client's heart failure?

Correct Answer: B

Rationale: The correct answer is B because assessing the client's ability to walk upstairs without fatigue helps determine the extent of heart failure. This question assesses the client's functional capacity and exercise tolerance, which are key indicators of heart failure severity. If the client experiences fatigue while walking upstairs, it indicates decreased cardiac output and potential heart failure progression. Other choices are incorrect as they focus on symptoms (A), nocturnal dyspnea (C), and peripheral edema (D), which may be present in heart failure but do not directly assess the extent of heart failure like exercise tolerance does.

Question 3 of 5

A client with heart failure expresses feelings of burden and thoughts of death to a nurse. How should the nurse respond?

Correct Answer: A

Rationale: The correct answer is A because it demonstrates active listening and empathy, encouraging the client to express their feelings further. This response shows support and openness to discuss sensitive topics, promoting therapeutic communication. Choice B fails to address the client's emotional distress directly. Choice C may invalidate the client's feelings. Choice D may not be appropriate unless the client expresses interest in meeting with the chaplain. Overall, option A is the best response for addressing the client's emotional needs effectively.

Question 4 of 5

A client who is intubated and has an intra-aortic balloon pump is restless and agitated. What action should the nurse perform first for comfort?

Correct Answer: A

Rationale: The correct answer is A: Allow family members to remain at the bedside. This is the priority action as it provides emotional support and comfort to the client. Having familiar faces around can help calm the client and reduce agitation. It also promotes a sense of security and connection. Choices B, C, and D are incorrect because they do not address the client's immediate need for comfort and emotional support. Asking about a fan, tuning the TV, or speaking loudly do not directly address the client's restlessness and agitation. Prioritizing the presence of family members is essential in this situation.

Question 5 of 5

The client with a chest tube after a coronary artery bypass graft has significantly slowed drainage. What action is most important for the nurse to take?

Correct Answer: B

Rationale: The correct answer is B: Notify the provider immediately. This is the most important action because significantly slowed drainage in a client with a chest tube after surgery can indicate a potential complication like a blocked tube or bleeding. Notifying the provider allows for prompt assessment and intervention to prevent further complications. Increasing the suction setting (choice A) without knowing the reason for slowed drainage can potentially worsen the situation. Re-positioning the chest tube (choice C) may not address the underlying issue causing the slowed drainage. Taking the tubing apart to assess for clots (choice D) should not be done by the nurse as it can introduce the risk of infection and requires sterile technique.

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