A nurse is caring for a client who has cancer. The client tells the nurse, "I would prefer to try vitamins and minerals instead of chemotherapy." Which of the following responses should the nurse make?

"I have never heard of any holistic treatment that is effective."

"Tell me what you know about chemotherapy."

"You should ask your provider about your plan."

"The best way to treat your cancer is chemotherapy "

Answer and Explanation

The Correct Answer is C

Rationale:

A. "I have never heard of any holistic treatment that is effective." This response is dismissive. It is important for the nurse to acknowledge the client’s concerns without shutting down the discussion or disregarding the client’s preferences.

B. "Tell me what you know about chemotherapy." While asking the client to share what they know about chemotherapy can provide insight, it doesn't directly address the client’s preference for alternative treatment.

C. "You should ask your provider about your plan." This response encourages the client to have an open conversation with their healthcare provider about their treatment options, including the use of vitamins and minerals. It respects the client’s autonomy and supports informed decision-making with professional guidance.

D. "The best way to treat your cancer is chemotherapy." This statement is prescriptive and does not acknowledge the client’s preferences or values. A more collaborative approach would involve discussing treatment options, risks, and benefits, while providing the client with the opportunity to make an informed decision.

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Correct Answer is ["A","B","C","D"]

Explanation

Rationale:

A. Check the client's airway and level of consciousness: The first priority is to assess the client's airway and level of consciousness to ensure that they are breathing properly and to gauge the severity of the condition.

B. Assess vital signs to determine hydration status: After assessing the airway and consciousness, it’s crucial to evaluate vital signs to determine the client's hydration status, as dehydration is a significant concern in diabetic ketoacidosis.

C. Administer prescribed IV fluids: IV fluids should be administered promptly to treat dehydration, restore electrolyte balance, and help improve circulation. This is typically the next step after assessing vital signs and hydration status.

D. Monitor for pulmonary edema: Once the IV fluids are being administered, the nurse should monitor for potential complications, such as pulmonary edema, which can occur due to fluid overload or other factors related to treatment.

A. Client urinating 100 mL/hour. B. Client is tolerating soft diet and oral fluids. C. Bowel sounds are hyperactive in all 4 quadrants. D. Bilateral pedal pulses 2+. E. Blood glucose 310 mg/dL (74 to 106 mg/dL) F. Pulse rate 84/min G. Blood pressure 106/76 mm Hg

Correct Answer is ["A","B","D","E","F","G"]

Explanation

Rationale for correct findings:

Client is urinating 100 mL/hour: This indicates improved kidney perfusion and rehydration. At 0900, the client reported frequent urination, which was likely osmotic diuresis leading to dehydration. A consistent urine output of 100 mL/hour suggests effective fluid resuscitation and that the kidneys are now functioning more optimally.
Client is tolerating soft diet and oral fluids: The ability to tolerate a soft diet and oral fluids suggests that the client is recovering from nausea and dehydration. This is an important indicator of improvement in gastrointestinal function and overall metabolic status.
Pulse rate decreased to 84/min: The pulse rate has decreased from 110/min to 84/min, indicating that the client’s cardiovascular status is improving, likely due to improved hydration and metabolic control.
Blood pressure increased to 106/76 mm Hg: The client’s blood pressure has improved from 96/65 mm Hg to 106/76 mm Hg, reflecting a more stable circulatory volume and better perfusion. This improvement suggests that fluid resuscitation is helping to stabilize the client’s hemodynamic status.
Blood glucose decreased to 310 mg/dL: A decrease in blood glucose from 468 mg/dL to 310 mg/dL shows that insulin therapy is having a positive effect on reducing hyperglycemia. The blood glucose level is still high but moving in the right direction, indicating recovery from the acute phase of hyperglycemia.

Rationale for Incorrect Finding:

Bowel sounds are hyperactive in all 4 quadrants: Hyperactive bowel sounds remain unchanged from the initial assessment. It is not a sign of improvement, and could be related to the stress response, medications, or ongoing issues with the gastrointestinal system.

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A nurse is caring for a client who has cancer. The client tells the nurse, "I would prefer to try vitamins and minerals instead of chemotherapy." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an emergency department is caring for a client whose blood glucose level indicates diabetic ketoacidosis. Identify the sequence of actions the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Correct Answer is ["A","B","C","D"]

Explanation

Correct Answer is ["A","B","D","E","F","G"]

Explanation

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