A 45-year-old woman has just undergone a radical hysterectomy for invasive cervical cancer. Prior to the surgery, the healthcare provider explained to the client that after the surgery an internal source of radiation would be placed near the tumor site to aid in reducing recurrence. Based on this information, the nurse knows to educate the client on which safety precaution?

The client should avoid crowded places.

The client should avoid eating fresh fruits and vegetables.

The client should maintain at least 6 feet from any visitors.

The client should avoid washing off the radiation tattoo markings.

Answer and Explanation

The Correct Answer is C

A. Avoiding crowded places is a precaution related to general health and infection control but is not specifically linked to internal radiation therapy.
B. Avoiding fresh fruits and vegetables is not required for internal radiation therapy. Dietary restrictions are not typically necessary unless specified by the healthcare provider.
C. For internal radiation therapy, maintaining distance from others, typically around 6 feet, is important to minimize radiation exposure to others. This safety measure helps reduce the risk of radiation exposure to family members and visitors.
D. Radiation tattoo markings are used to ensure proper placement of the radiation source and should not be washed off. However, this precaution does not directly relate to safety around radiation exposure.

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Correct Answer is D

Explanation

A. Vasopressin does not typically increase the client's heart rate; its primary effect is on the kidneys and urine output.
B. Vasopressin generally increases blood pressure by promoting vasoconstriction, not decreases it.
C. Vasopressin will increase, not decrease, urine specific gravity by reducing urine output and concentrating the urine.
D. Vasopressin acts to decrease urine output by increasing water reabsorption in the kidneys, which helps manage diabetes insipidus.

A. Restrict the client's intake of sodium. B. Administer vitamin K. C. Reduce the client's intake of protein. D. Administer diuretics.

Correct Answer is C

Explanation

A. Restricting sodium intake is essential in managing ascites and edema in cirrhosis, but it does not directly reduce ammonia levels. Sodium restriction is more related to fluid management rather than ammonia reduction.
B. Administering vitamin K may be necessary for correcting coagulation issues in liver disease, but it does not address the elevated ammonia levels causing encephalopathy.
C. Reducing protein intake is crucial for decreasing ammonia production. In clients with hepatic encephalopathy, proteins are broken down into ammonia, which the impaired liver cannot detoxify effectively, leading to worsened symptoms. Therefore, reducing dietary protein can help lower ammonia levels.
D. Administering diuretics is used to manage fluid retention and ascites in cirrhosis, but it does not directly impact ammonia levels. Diuretics are not the primary intervention for hepatic encephalopathy.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a student nurse about the effects of vasopressin that is prescribed for a client with diabetes insipidus. Which statement by the student nurse indicates an understanding of the teaching?

Correct Answer is D

Explanation

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level?

Correct Answer is C

Explanation

A client with Meniere disease is instructed to modify his diet. The nurse would explain that which item would be acceptable for the client to include?

A nurse witnesses a motor vehicle crash and finds a client who is not breathing. The nurse suspects the client has a cervical vertebrae fracture. Which of the following actions should the nurse take first?

The nurse is assessing a client with a new diagnosis of multiple sclerosis. Which manifestations would the nurse expect to see that are common early signs of multiple sclerosis?

A nurse is teaching a client who has a new diagnosis of gout about managing the disorder. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is providing discharge planning for a client who has just been diagnosed as being in the early stage of rheumatoid arthritis and starting methotrexate. What should the nurse include in the client's teaching?

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L (nl. 135-145 mEq/L). Which of the following prescriptions should the nurse anticipate?

A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. Based on the most recent assessment findings, the nurse should perform which action?