1. Which of the following statements should be included when teaching a client newly diagnosed with testicular cancer?
1. Testicular cancer isn't responsive to chemotherapy, but it's highly curative with surgery.
2. Radiation therapy is never used, so the unaffected testicle remains healthy.
3. Testicular self-examination still is important because your risk for a second tumor is increased.
4. Taking testosterone after orchiectomy prevents changes in appearance and sexual function.
2. Care for an indwelling urinary catheter should include which of the following interventions?
1. Insert the catheter using clean technique.
2. Keep the drainage bag on the bed with the client.
3. Remove obvious encrustations from the external catheter surface by washing it gently with soap and water.
4. Lay the drainage bag on the floor to allow for maximum drainage through gravity.
3. A client with end-stage renal disease arrives at the hospital with a blood pressure of 200/100 mm Hg, heart rate of 110 beats/minute, and a respiratory rate of 36 breaths/minute. Oxygen saturation on room air is 89%. He complains of shortness of breath, and you note +2 pedal edema. His last hemodialysis treatment was yesterday. Which of the following interventions should you do first?
1. Administer oxygen.
2. Elevate the foot of the bed.
3. Restrict the client's fluids.
4. Prepare the client for hemodialysis.
4. A client is admitted with severe nausea, vomiting, and diarrhea and is hypotensive. She's noted to have oliguria with an elevated blood urea nitrogen (BUN) level. The health care provider probably will write an order for which one of the following treatments?
1. Force oral fluids.
2. Give furosemide 20 mg I.V.
3. Start hemodialysis after a temporary access is obtained.
4. Start I.V. infusion of normal saline solution bolus followed by a maintenance infusion.
5. A surgical client has just been admitted to the recovery room after a colon resection. You check the dressing for indications of which of the following complications?
2. paralytic ileus
6. Which of the following interventions is most appropriate for preventing pressure ulcers in a bedridden elderly client?
1. Slide instead of lift the client when turning.
2. Turn and reposition the client at least every 8 hours.
3. Apply lotion after bathing the client, and vigorously massage her skin.
4. Post a turning schedule at the client's bedside, and adapt position changes to her situation.
7. Which one of the following practices would you recommend to a client who's had a cesarean delivery?
1. frequent douching after she's discharged
2. coughing and deep-breathing exercises
3. sit-ups at 2 weeks postoperatively
4. side-rolling exercises
Answers and rationales
1. 3 A history of a testicular malignancy puts the client at increased risk for a second tumor. Testicular self-examination is critical because it allows for early detection and treatment. Chemotherapy is added for clients who have evidence of metastasis after radiation therapy, which is used on the retroperitoneal lymph nodes. Testosterone usually isn't needed because the unaffected testis typically produces sufficient hormone.
2. 3 Vigorous cleaning of the meatus while the catheter's in place isn't recommended, but the area can be gently washed with soap and water to remove obvious encrustations from the external catheter surface. Insert the catheter using sterile technique. To avoid backflow of contaminated urine into the bladder and increasing the chance of infection, don't raise the collection bag above the level of the client's bladder. To prevent contamination of the closed system, never let the drainage bag touch the floor; hang it on the bed in a dependent position.
3. 1 Airway and oxygenation always are the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, you need to administer oxygen to increase the Pao2. After taking care of airway and oxygenation, you'd also need to ensure that the client is dialyzed and his fluids restricted. The foot of the bed may be elevated to reduce edema, but this isn't a priority.
4. 4 The client is hypovolemic secondary to fluid losses and needs to be rehydrated with I.V. fluids; her urine output should increase, and the BUN level normalize. She wouldn't be able to tolerate oral fluids due to the nausea, vomiting, and diarrhea. She isn't fluid overloaded, and her urine output won't increase with furosemide. She won't need dialysis because the oliguria and increased BUN level is due to dehydration.
5. 4 In the immediate postoperative phase, hemorrhage is a possibility. Peritonitis, paralytic ileus, and dehiscense are all complications that may occur later, but not immediately after surgery.
6. 4 Posting a turning schedule with a signing sheet will make sure the client gets turned. When moving her, lift, rather than slide, her to avoid shearing. Turn a client who's in bed for prolonged periods every 1 to 2 hours. Apply lotion to keep the skin moist, but avoid vigorous massage to avoid damaging capillaries.
7. 2 Teach any postoperative client coughing and deep-breathing exercises to keep the alveoli open and prevent pulmonary infection. Frequent douching isn't recommended for any women and is contraindicated in those who've just given birth. Sit-ups at 2 weeks postpartum could damage the healing incision. Side-rolling exercises aren't an accepted medical practice.
Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 2nd ed., Lippincott Williams & Wilkins, 2003.