The nurse is caring for a client diagnosed with leukemia who has just completed a course of radiation therapy and chemotherapy in preparation for a bone marrow transplant. The nurse notices that the client is febrile, has foul smelling urine, and is complaining of urinary frequency and dysuria. What is the priority nursing action?

Request medical prescription for an antibiotic such as gentamicin

Obtain a full set of vital signs and have the client void in a specimen cup

Increase intake of oral fluids such as cranberry juice

Place the client in protective isolation

Answer and Explanation

The Correct Answer is B

A.   While antibiotics may be necessary if a UTI is confirmed, requesting a prescription would not be the immediate nursing action. The nurse must first assess the situation thoroughly and obtain necessary diagnostic information before medications can be prescribed.
B.   This option is the most appropriate immediate action. Obtaining a full set of vital signs helps assess
the client’s overall condition, including the degree of fever and any signs of systemic infection. Collecting

a urine specimen will facilitate further evaluation, such as a urinalysis and culture, to confirm a UTI and identify the appropriate antibiotic treatment.
C.   While increasing fluid intake can help with urinary tract health and dilute the urine, it is not an immediate priority in this situation. The client may need more urgent assessment and possible medical intervention rather than just dietary changes.
D.   Although protective isolation may be warranted given the client’s immunocompromised state due to chemotherapy and radiation, it is not the immediate priority based on the current symptoms. The focus should first be on assessing and addressing the potential UTI.

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Correct Answer is B

Explanation

A. A carotid endarterectomy does not involve bypassing the plaques; rather, it directly addresses the blockage.
B. Carotid endarterectomy is a surgical procedure that involves making an incision in the neck to access the carotid artery, where the surgeon removes the atherosclerotic plaques that are causing narrowing and restricting blood flow. This helps reduce the risk of stroke.
C. Carotid endarterectomy is not brain surgery; it is performed on the carotid arteries in the neck. The procedure aims to prevent strokes by improving blood flow to the brain, but it does not involve surgery on the brain itself.
D. This description does not accurately reflect carotid endarterectomy. The procedure does not involve resecting an artery in the brain or using a graft; rather, it focuses on removing plaques from the carotid artery in the neck.

A. "Is the 'lump' painful?" B. "Have you had any trouble urinating?" C. "Have you had unprotected sex recently?" D. "Do you have any discharge from your penis?"

Correct Answer is A

Explanation

A. This response is relevant and helps assess the characteristics of the lump. Pain can be an important factor in differentiating between conditions, such as epididymitis, testicular torsion, or tumors. However, while it is a useful question, it may not provide a comprehensive assessment of the situation.
B. This question can be relevant depending on the underlying cause of the lump. Issues with urination may suggest a problem related to the prostate or bladder rather than the testicle itself. While it can help assess urinary tract involvement, it may not directly address the significance of the lump in the testicle.
C. This question is important in the context of sexually transmitted infections (STIs), which can cause scrotal swelling or lumps due to conditions like epididymitis or orchitis. However, it does not directly assess the lump itself, making it less focused on the immediate concern.
D. This question addresses the possibility of an STI and related conditions. While it is relevant, it is not the best immediate question concerning the lump in the testicle. The presence of discharge may not directly correlate with the testicular lump itself.

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Naxlex Comprehensive Predictor Exams

The physician recommends a carotid endarterectomy for a client with atherosclerosis and a history of transient ischemic attacks (TIAS). The nurse explains that this procedure involves:

Correct Answer is B

Explanation

The nurse is caring for a male patient who complains about a small "lump" that he discovered in his right testicle. What would be the best response by the nurse?

Correct Answer is A

Explanation

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