While assessing an older adult client, the nurse notes that the client has old and new ecchymotic areas on the extremities and buttocks upon admission. The client states to the nurse in confidence that the family members frequently hit him. Which therapeutic statement should the nurse communicate in response?

Let's get these treated

I'll report this type of abuse

Call the emergency department

I'll keep this in confidence

Answer and Explanation

The Correct Answer is B

Choice A reason: While treating the injuries is important, addressing the root cause of abuse is crucial for the client's safety. Simply treating the injuries without addressing the abuse may allow the cycle of harm to continue.

Choice B reason: Reporting the abuse is a legal and ethical responsibility for healthcare providers. Ensuring the client's safety and providing necessary interventions to stop the abuse is paramount.

Choice C reason: Calling the emergency department is not the correct response. The nurse should follow the proper protocol for reporting abuse, which involves notifying social services or other relevant authorities.

Choice D reason: Keeping the information in confidence is not appropriate when dealing with abuse cases. The nurse must act to protect the client and report the abuse to prevent further harm.

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Correct Answer is D

Explanation

Choice A reason: Bright light sensitivity is a common side effect following cataract surgery and can be managed with appropriate measures such as wearing sunglasses. It does not necessarily indicate a complication requiring immediate reporting.

Choice B reason: Difficulty seeing with a patch on one eye and fear of falling are valid concerns, but they do not necessarily indicate an immediate complication that requires urgent reporting to the healthcare provider.

Choice C reason: Eye itching is common after cataract surgery, and the client should be advised not to rub the eye to prevent infection or damage. This comment does not indicate a severe complication that needs immediate reporting.

Choice D reason: Severe eye pain that the client cannot stand is a potential sign of a serious complication, such as increased intraocular pressure, infection, or other postoperative issues. This requires immediate attention from the healthcare provider to prevent further complications and ensure the client's safety.

A. Pyridostigmine orally B. Tensilon intravenously C. Hydrocortisone intravenously D. Spironolactone intramuscularly

Correct Answer is C

Explanation

Choice A reason: Pyridostigmine is used to treat myasthenia gravis, not for preventing Addisonian crisis in patients undergoing adrenalectomy. It is not related to adrenal hormone replacement.

Choice B reason: Tensilon (edrophonium) is used in the diagnosis of myasthenia gravis and is not relevant for managing adrenal insufficiency or preventing Addisonian crisis.

Choice C reason: Hydrocortisone intravenously is the correct choice for preventing Addisonian crisis in a client scheduled for adrenalectomy. Hydrocortisone provides the necessary corticosteroid replacement to manage the deficiency of adrenal hormones during and after surgery.

Choice D reason: Spironolactone is a potassium-sparing diuretic used to treat conditions like heart failure and hypertension. It is not used for preventing Addisonian crisis or managing adrenal insufficiency.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client following cataract surgery. Which comment from the client should the nurse report to the client's health care provider IMMEDIATELY?

Correct Answer is D

Explanation

The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addisonian Crisis?

Correct Answer is C

Explanation

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful to monitor?

A client received atropine intraoperatively for symptomatic sinus bradycardia during a cardiac catheterization. In the immediate postoperative period, the nurse monitors the client for which effects of the medication?

A client prescribed albuterol sulfate by inhalation is unable to cough up secretions. What actions should the nurse teach the client to help clear bronchial secretions effectively?

The nurse is teaching a client with newly diagnosed asthma. Which instructions should the nurse include to reduce the likelihood of an asthma attack? (Select all that apply)

During an emergency code situation, a primary healthcare provider about to defibrillate a client diagnosed with ventricular fibrillation says in a loud voice, "CLEAR!" Which action should the nurse implement immediately?

There are several factors that may cause a patient to present with sinus bradycardia. What are some causes of sinus bradycardia? (Select all that apply)

A client newly diagnosed with angina pectoris has taken two sublingual nitroglycerin tablets for chest pain. The chest pain is relieved, but the client now reports a headache. The nurse interprets that this most likely represents which response?

A client with myxedema reports experiencing fatigue, cold intolerance, and swelling around the eyes and face. The nurse plans care, understanding that these clinical manifestations are caused by a lack of or diminished production of which hormones? (Select all that apply)