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1. A client undergoing radiation therapy is being taught about skin care by a nurse. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will use a heating pad to soothe the skin
- B. I will avoid using perfumed lotions on the treated area
- C. I will apply cold compresses to the area
- D. I will scrub the area daily with soap and water
Correct answer: B
Rationale: The correct answer is B because avoiding perfumed lotions is important to prevent skin irritation after radiation therapy. Using a heating pad (A) can further damage the skin, applying cold compresses (C) may not be recommended, and scrubbing the area daily with soap and water (D) can be too harsh on the skin, leading to further irritation and damage.
2. A client with a new diagnosis of type 2 diabetes mellitus inquires about information concerning oral antidiabetic agents. In addition to the provider, where should the nurse refer the client for information?
- A. Family members
- B. Pharmacist
- C. Dietitian
- D. American Diabetes Association
Correct answer: D
Rationale: The correct answer is D: American Diabetes Association. The American Diabetes Association is a reputable source that provides credible information on managing diabetes. While family members can offer support, they may not have the specialized knowledge on oral antidiabetic agents. Pharmacists are knowledgeable about medications but may not provide comprehensive information on diabetes management. Dietitians can offer valuable advice on nutrition but may not cover specific details about oral antidiabetic agents. Therefore, referring the client to the American Diabetes Association ensures access to accurate and detailed information related to their condition.
3. When a nurse questions a medication prescription as too extreme due to a client's advanced age and unstable status, this action exemplifies which ethical principle?
- A. Fidelity
- B. Autonomy
- C. Justice
- D. Non-maleficence
Correct answer: D
Rationale: The correct answer is D: Non-maleficence. Non-maleficence refers to the ethical principle of avoiding harm. In this scenario, the nurse questions the medication prescription to prevent potential harm to the client, demonstrating the principle of non-maleficence. Choice A, fidelity, pertains to being faithful and keeping promises, which is not the focus of the scenario. Choice B, autonomy, relates to respecting a client's right to make decisions about their care, not the nurse's actions. Choice C, justice, involves fairness and equal treatment, which is not directly applicable to the nurse questioning a medication prescription to prevent harm.
4. A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings indicates a hemolytic transfusion reaction?
- A. Chills
- B. Bradycardia
- C. Hypertension
- D. Low back pain
Correct answer: D
Rationale: Low back pain is a classic sign of a hemolytic transfusion reaction and requires immediate intervention. Chills are more commonly associated with a febrile non-hemolytic transfusion reaction. Bradycardia is not a typical sign of a hemolytic transfusion reaction. Hypertension is not a common finding in a hemolytic transfusion reaction.
5. A healthcare professional is preparing to administer a blood transfusion. What is the first step?
- A. Administer the blood through an IV push
- B. Verify that the client's blood type matches the blood product
- C. Ensure the client has eaten before the transfusion
- D. Administer a diuretic before starting the transfusion
Correct answer: B
Rationale: The correct first step before administering a blood transfusion is to verify that the client's blood type matches the blood product. This step is crucial to prevent transfusion reactions due to incompatibility. Choice A is incorrect because blood should not be administered through an IV push for a blood transfusion. Choice C is incorrect because it is not necessary for the client to eat before a blood transfusion. Choice D is incorrect because administering a diuretic is not a standard practice before starting a blood transfusion.
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