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1. A healthcare professional is reviewing the medical records of a client who has a pressure ulcer. Which of the following is an expected finding?
- A. Serum albumin level of 3 g/dL
- B. HDL level of 90 mg/dL
- C. Norton scale score of 18
- D. Braden scale score of 20
Correct answer: A
Rationale: A serum albumin level of 3 g/dL is indicative of poor nutrition, which is commonly associated with pressure ulcers. This finding suggests that the client may be at risk for developing or already has a pressure ulcer due to malnutrition. High-density lipoprotein (HDL) level of 90 mg/dL (Choice B) is not directly related to pressure ulcers. The Norton scale (Choice C) is used to assess a client's risk of developing pressure ulcers, not as a finding in a client with an existing pressure ulcer. The Braden scale (Choice D) is also a tool used to assess the risk of developing pressure ulcers, not a finding in a client with an existing pressure ulcer.
2. A community health nurse is helping to reinforce teaching about hepatitis A with a group of employees at a childcare facility. Which of the following characteristics should the nurse identify as an external factor that can impede learning for the participants?
- A. High workload
- B. Limited knowledge on the subject
- C. Poor lighting
- D. Limited space in the learning area
Correct answer: C
Rationale: The correct answer is C: 'Poor lighting.' External factors such as lighting can significantly impact the learning environment, making it difficult for participants to engage effectively. Poor lighting can strain the eyes, cause discomfort, and lead to decreased concentration. Choices A, B, and D are internal factors or issues that are not directly related to the learning environment. High workload, limited knowledge on the subject, and limited space in the learning area may affect learning differently but do not impede learning through external factors like poor lighting does.
3. A client takes prednisone daily for the treatment of chronic asthma. The nurse should plan to monitor the client for which of the following adverse effects?
- A. Hyperglycemia
- B. Hypertension
- C. Gastric ulcer formation
- D. Diarrhea
Correct answer: C
Rationale: The correct answer is C: Gastric ulcer formation. Prednisone, a corticosteroid, increases the risk of gastric ulcer formation, especially with long-term use. While prednisone can also lead to hyperglycemia (choice A) and hypertension (choice B) as adverse effects, monitoring for gastric ulcer formation is a priority due to its association with corticosteroid therapy. Diarrhea (choice D) is not a common adverse effect of prednisone and is less likely compared to gastric ulcers.
4. A client undergoing chemotherapy for cancer is being taught about potential adverse effects of the treatment. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will avoid drinking water before meals
- B. I might experience hair loss during treatment
- C. I might experience an increase in appetite
- D. I should expect my appetite to increase
Correct answer: B
Rationale: The correct answer is B because hair loss is a common adverse effect of chemotherapy. Options A, C, and D are incorrect. Avoiding drinking water before meals, experiencing an increase in appetite, or expecting appetite to increase are not related to the potential adverse effects of chemotherapy.
5. A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect?
- A. Polyuria.
- B. Dehydration.
- C. Hyponatremia.
- D. Hyperglycemia.
Correct answer: C
Rationale: The correct answer is C: Hyponatremia. In SIADH, there is excessive release of antidiuretic hormone, causing water retention and dilutional hyponatremia. Polyuria (choice A) is increased urination, which is not a typical finding in SIADH. Dehydration (choice B) is the loss of body fluids, which is opposite to the fluid retention seen in SIADH. Hyperglycemia (choice D) is elevated blood sugar levels and is not directly related to SIADH.
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