The nurse is caring for a client who has had a stroke and who has received tissue plasminogen activator (t-PA) on admission. The family member requests to bring in a razor for the client to use. Which response from the family would indicate an understanding teaching related to t-PA? The family member states, "I will

be careful with the straight razor."

insist the nurse use multiple razor blades."

bring in an electric razor for nurse to use for shaving."

bring in disposable razors blades to use for, shaving."

Answer and Explanation

The Correct Answer is C

A.   This response shows some awareness but does not indicate a sufficient understanding of the risks. Straight razors can pose a significant risk of cuts and bleeding, especially in a patient who has received t- PA, which can increase the likelihood of bleeding.
B.   This response suggests a misunderstanding. Using multiple razor blades does not inherently reduce the risk of bleeding and could increase the chance of cuts or nicks. This response does not indicate an appropriate understanding of safety precautions related to t-PA.
C.   This response indicates an understanding of safety precautions. Electric razors are safer for clients who are at risk of bleeding because they do not have sharp blades that can easily cause cuts. This choice minimizes the risk of injury while allowing for personal grooming.
D.   While disposable razors may seem convenient, they still carry a risk of cuts and bleeding. This response does not reflect a full understanding of the precautions necessary for a client who has received t-PA, as it does not prioritize safety in the same way that using an electric razor does.

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Correct Answer is B

Explanation

A. This statement is false in terms of being a major risk factor for cervical cancer. While excessive alcohol consumption may have various health implications, moderate drinking, such as a glass of red wine with dinner, is not directly linked to an increased risk of cervical cancer.

B. Infection with certain high-risk strains of HPV is a major risk factor for cervical cancer. HPV is a sexually transmitted virus that can cause changes in cervical cells, leading to dysplasia and potentially progressing to cancer if not monitored and treated.
C. In fact, regular Pap tests are a preventive measure that can help detect cervical changes early before they develop into cancer. They are not a risk factor but rather a protective factor against the progression of cervical dysplasia to cancer.
D. While sexual history can influence HPV transmission, simply being married to the same person for an extended period does not inherently increase the risk of cervical cancer.

A. Complaints of pain at the incision B. Increased blood pressure C. Decreased white blood cell count D. Presence of blood on the pillow behind the patient

Correct Answer is D

Explanation

A. While pain can occur post-operatively and may be a sign of complications, it is not a direct indicator of bleeding. Pain can result from normal healing, surgical trauma, or other complications, but by itself, it does not specifically point to bleeding at the surgical site.
B. An increased blood pressure might not necessarily indicate bleeding. In some cases, blood pressure may increase due to pain, anxiety, or other factors. However, a significant drop in blood pressure would be more indicative of bleeding, especially in conjunction with other symptoms.
C. A decreased white blood cell count (leukopenia) is not typically associated with bleeding at the surgical site. In fact, following surgery, one might expect the white blood cell count to be normal or slightly elevated due to the body’s response to surgery.
D. This finding is indicative of bleeding at the surgical site. Blood on the pillow would suggest that there is active bleeding that has escaped from the surgical site, which is a significant concern that requires immediate assessment and intervention.

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Naxlex Comprehensive Predictor Exams

A client's Pap test reveals cervical cells with dysplasia changes. The nurse understands that information obtained during the client's health history and identified as a major risk factor for cervical cancer is:

Correct Answer is B

Explanation

The nurse is assessing a post-op thyroidectomy patient for bleeding. Which finding would indicate bleeding at the surgical site?

Correct Answer is D

Explanation

The husband of a client with cervical carcinoma in situ says to the nurse, "The doctor just told my wife that her cancer is curable. Is the doctor just trying to make us feel better?" The nurse's most accurate response would be:

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