Choice A reason: Asking the client why they think they might have cancer when their diagnosis is benign can come across as dismissive and may not address the client’s underlying anxiety. It is important for the nurse to acknowledge the client’s feelings and provide support rather than questioning their concerns.

Choice B reason: Telling the client that there is no reason to worry based on their chart can be seen as dismissive of their feelings. While it may be factually correct, it does not address the client’s emotional state or provide the support they need.

Choice C reason: This response acknowledges the client’s concern and opens the door for further discussion. It shows empathy and understanding, which can help the client feel heard and supported. This approach aligns with therapeutic communication techniques that encourage clients to express their feelings and concerns.

Choice D reason: Suggesting that the client discuss their concerns with their provider is not incorrect, but it may not provide the immediate emotional support the client needs. While it is important for the client to have a detailed discussion with their provider, the nurse should first acknowledge and address the client’s immediate concerns.

Choice A reason: Taking aspirin while on prednisone can increase the risk of gastrointestinal bleeding. Prednisone, a corticosteroid, can cause stomach irritation, and combining it with aspirin, a nonsteroidal anti-inflammatory drug (NSAID), can exacerbate this effect. Therefore, clients should avoid taking aspirin for minor aches and pains while on prednisone.

Choice B reason: A sore throat is not a common side effect of prednisone. Prednisone can suppress the immune system, making clients more susceptible to infections, but it does not typically cause a sore throat within the first week of use. If a client experiences a sore throat, they should contact their healthcare provider as it may indicate an infection.

Choice C reason: Clients on prednisone should avoid live vaccines, such as the flu vaccine, within one week of starting the medication. Prednisone can weaken the immune system, reducing the effectiveness of the vaccine and increasing the risk of developing the illness the vaccine is meant to prevent. It is generally recommended to consult with a healthcare provider before receiving any vaccines while on prednisone.

Choice D reason: Prednisone can cause potassium loss, leading to hypokalemia. Eating more bananas, which are high in potassium, can help counteract this effect and maintain normal potassium levels. Normal potassium levels range from 3.5 to 5.0 mEq/L. Therefore, clients should increase their intake of potassium-rich foods like bananas while taking prednisone.

Choice A reason: There are no current occurrences of smallpox. Smallpox was declared eradicated in 1980 by the World Health Organization (WHO) after a successful global vaccination campaign. Therefore, the statement that there are rare, occasional occurrences of smallpox is incorrect.

Choice B reason: Smallpox lesions do not appear in various stages of healing at the same time. Unlike chickenpox, where lesions can be in different stages of healing simultaneously, smallpox lesions typically develop and progress through stages uniformly. This means that all lesions are generally at the same stage of development at any given time.

Choice C reason: The vesicles of smallpox are indeed more abundant on the face and extremities compared to the trunk. This distribution pattern is a distinguishing feature of smallpox, as opposed to chickenpox, which tends to have a more central distribution with more lesions on the trunk.

Choice D reason: Vaccination against smallpox provides lifelong immunity. The smallpox vaccine, which uses a live virus related to smallpox called vaccinia, has been shown to provide long-lasting immunity. Studies have indicated that immunity can last for decades, and even those vaccinated many years ago retain some level of protection.

Choice A reason: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. ACE inhibitors can cause orthostatic hypotension, especially in older adults, due to their vasodilatory effects, which can lead to a sudden drop in blood pressure upon standing.

Choice B reason: Clopidogrel is an antiplatelet medication used to prevent blood clots in patients with cardiovascular diseases. It does not typically cause orthostatic hypotension. Its primary side effects are related to bleeding and bruising, rather than blood pressure changes.

Choice C reason: Atorvastatin is a statin used to lower cholesterol levels and reduce the risk of cardiovascular disease. Statins do not generally cause orthostatic hypotension. Their side effects are more commonly related to muscle pain and liver enzyme abnormalities.

Choice D reason: Furosemide is a loop diuretic used to treat edema and hypertension. Diuretics can cause orthostatic hypotension by reducing blood volume and altering electrolyte balance, leading to a decrease in blood pressure upon standing.

Choice E reason: Doxazosin is an alpha-blocker used to treat high blood pressure and benign prostatic hyperplasia. Alpha-blockers are well-known for causing orthostatic hypotension due to their mechanism of action, which involves relaxing blood vessels and reducing blood pressure.

Choice A reason: Intention tremors are not typically associated with Addison’s disease. Intention tremors are more commonly seen in conditions affecting the cerebellum, such as multiple sclerosis or cerebellar ataxia.

Choice B reason: Purple striations (striae) are more commonly associated with Cushing’s syndrome, which is characterized by excessive cortisol levels. Addison’s disease, on the other hand, involves insufficient cortisol production.

Choice C reason: Hirsutism refers to excessive hair growth in women in areas where hair is normally minimal or absent. This condition is more commonly associated with polycystic ovary syndrome (PCOS) or other endocrine disorders, not Addison’s disease.

Choice D reason: Hyperpigmentation is a hallmark sign of Addison’s disease. It occurs due to increased production of melanocyte-stimulating hormone (MSH) as a byproduct of elevated adrenocorticotropic hormone (ACTH) levels. This leads to darkening of the skin, especially in areas exposed to friction, such as the elbows, knees, knuckles, and scars.

Choice A reason: Using handrails in the bathroom is an effective fall prevention strategy. Handrails provide support and stability, especially in wet and slippery conditions, reducing the risk of falls. Bathrooms are common places for falls due to the presence of water and slippery surfaces. Installing handrails can significantly enhance safety for elderly residents.

Choice B reason: Getting a longer cord for the telephone is not a recommended fall prevention strategy. Long cords can create tripping hazards, especially if they are not properly managed. It is better to use cordless phones or ensure that cords are kept short and out of walkways to prevent falls.

Choice C reason: Placing a throw rug over electrical cords is not advisable. Throw rugs can slip and slide, creating a significant tripping hazard. Additionally, covering electrical cords with rugs can cause overheating and pose a fire risk. It is safer to secure cords along walls and use non-slip mats if necessary.

Choice D reason: Using chairs without armrests is not recommended for fall prevention. Armrests provide support when sitting down and standing up, helping to maintain balance and stability. Chairs with armrests can reduce the risk of falls by providing additional support for elderly residents.

Choice A reason: Eating a snack half an hour before playing soccer is a good practice for children with type 1 diabetes. Physical activity can lower blood glucose levels, and having a snack beforehand helps prevent hypoglycemia. This statement indicates that the child understands the importance of managing blood glucose levels during exercise.

Choice B reason: My morning blood glucose should be between 90 and 130 is a correct statement regarding target blood glucose levels for children with type 1 diabetes. However, this statement alone does not indicate a comprehensive understanding of diabetes management, as it only addresses one aspect of blood glucose monitoring.

Choice C reason: I should not take my regular insulin when I am sick is incorrect. Children with type 1 diabetes should continue taking their insulin even when they are sick, as illness can cause blood glucose levels to rise. They may need to adjust their insulin dosage, but stopping insulin altogether can lead to dangerous complications like diabetic ketoacidosis.

Choice D reason: I can store unopened bottles of insulin in the freezer is incorrect. Insulin should be stored in the refrigerator, not the freezer. Freezing insulin can damage its effectiveness. Unopened insulin should be kept at a temperature between 36°F and 46°F (2°C to 8°C).

Choice A reason: Aspirating for a blood return before depressing the plunger is not recommended when administering enoxaparin. Enoxaparin is given subcutaneously, and aspiration is not necessary for subcutaneous injections. Aspiration can cause tissue damage and increase the risk of bleeding.

Choice B reason: Inserting the needle at a 45-degree angle is appropriate for subcutaneous injections if the patient has limited subcutaneous tissue. However, for enoxaparin, the preferred angle is 90 degrees to ensure the medication is delivered into the subcutaneous tissue.

Choice C reason: Not expelling the air bubble in the prefilled syringe is correct. The air bubble in the prefilled syringe of enoxaparin is designed to ensure the entire dose is administered and to prevent leakage of the medication. Expelling the air bubble can result in an incomplete dose.

Choice D reason: Administering the medication 2.54 cm (1 inch) from the umbilicus is correct for subcutaneous injections in the abdomen. However, this statement alone does not address the specific consideration of the air bubble in the prefilled syringe, which is crucial for enoxaparin administration.

Choice A reason: Transporting a school-age client who is in traction to another department is unsafe for a volunteer. Traction involves the use of weights and pulleys to align or immobilize a part of the body, typically after a fracture. This requires careful handling and monitoring to ensure the traction remains effective and does not cause additional injury. Only trained healthcare professionals should manage and transport clients in traction to prevent complications.

Choice B reason: Reading a book to a preschool client who has AIDS is a safe and appropriate assignment for a volunteer. AIDS (Acquired Immunodeficiency Syndrome) is not transmitted through casual contact such as reading a book together. Volunteers can provide emotional support and companionship to children with AIDS without risk of transmission.

Choice C reason: Playing a computer video game with an adolescent who has sickle cell disease is also a safe and suitable activity for a volunteer. Sickle cell disease is a genetic disorder that affects the shape of red blood cells, leading to various complications. However, it is not contagious, and engaging in recreational activities can help improve the adolescent’s quality of life and provide a sense of normalcy.

Choice D reason: Rocking an infant who was admitted for croup is a safe task for a volunteer. Croup is a respiratory condition characterized by a barking cough, often caused by a viral infection. While it can be contagious, the risk of transmission can be minimized with proper hygiene practices. Volunteers can provide comfort and soothing to infants with croup under the supervision of healthcare staff.

Choice A reason: 0.9% sodium chloride, also known as normal saline, is not the best choice for interim fluid replacement when TPN is delayed. While it can maintain hydration and electrolyte balance, it does not provide the necessary calories that TPN supplies. TPN solutions are rich in dextrose, amino acids, and lipids, which are essential for patients who cannot receive nutrition through their gastrointestinal tract.

Choice B reason: Dextrose 5% in water (D5W) provides some calories but not enough to meet the nutritional needs of a patient who is dependent on TPN. D5W contains 5 grams of dextrose per 100 mL, providing 170 calories per liter. This is insufficient for patients who require high-calorie intake due to their inability to eat or absorb nutrients normally.

Choice C reason: Dextrose 10% in water (D10W) is the most appropriate choice for interim fluid replacement when TPN is delayed. D10W provides 10 grams of dextrose per 100 mL, offering 340 calories per liter. This higher concentration of dextrose helps to maintain the patient’s caloric intake and prevent hypoglycemia until the next TPN container is available.

Choice D reason: Lactated Ringer’s solution is primarily used for fluid and electrolyte replacement. It contains sodium, potassium, calcium, chloride, and lactate, but it does not provide the necessary calories that TPN supplies. Therefore, it is not suitable for maintaining the nutritional needs of a patient who is dependent on TPN.