Extract:

Question 1 of 5

A client has been in the position shown in the figure for surgery. The nurse should document that the client has been in which of the following positions?

Correct Answer: C

Rationale: The client is in the lithotomy position. The reverse Trendelenburg position is when the client is lying supine with the head lower than the rest of the body. A low Fowler’s position is when the client is sitting up at a 30- to 45-degree angle. The prone position is when the client is lying face down.

Question 2 of 5

The nurse is reviewing the postoperative orders (see chart) just written by a physician for a client with insulin-dependent diabetes who has returned to the surgery floor from the recovery. The client has pain of 5 on a scale of 1 to 10. The hand-off report from the nurse in the recovery room indicated that the vital signs have been stable for the last 30 minutes. After obtaining the client's glucose level, the nurse should do which of the following first?

A. Administer the morphine. B. Contact the physician to report the glucose level and rewrite the insulin order. C. Administer oxygen per nasal cannula at 2 L/minute. D. Take the vital signs.

Correct Answer: B

Rationale: The glucose level must be assessed to determine if insulin is safe to administer, as hypoglycemia could worsen with insulin. Contacting the physician ensures appropriate insulin dosing.

Question 3 of 5

The nurse is teaching a client with a spinal fusion about body mechanics. Which client statement indicates understanding?

A. I'll bend at the waist to pick up objects.' B. I'll keep my back straight when lifting.' C. I'll twist my torso to reach objects.' D. I'll carry heavy items close to my chest.'

Correct Answer: B

Rationale: Keeping the back straight during lifting protects the surgical site and maintains spinal alignment.

Question 4 of 5

A client on peritoneal dialysis reports cloudy effluent. The nurse should:

A. Continue the exchange. B. Notify the physician. C. Increase dwell time. D. Administer pain medication.

Correct Answer: B

Rationale: Cloudy effluent suggests peritonitis, requiring immediate medical attention.

Question 5 of 5

Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system?

A. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy. B. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. C. Long-term immunologic effects have been studied only in clients with breast and lung cancer. D. The helper T cells recover more rapidly than the suppressor T cells, which results in positive helper cell balance that can last 5 years.

Correct Answer: B

Rationale: Radiation and combination chemotherapy can cause significant and prolonged immune suppression, increasing infection risk, which is a well-documented long-term effect.