Question

Use the table below to answer questions 1 to 3.

The nurse is reviewing laboratory values of a 52-year-old male client who recently completed his first cycle of chemotherapy infusion for small cell lung cancer treatment.

Answer 1

Correct Answers:

Syndrome of inappropriate antidiuretic hormone

Rationale :

💧The client’s low sodium (126 mEq/L), low serum osmolality (268 mOsm/kg), and high urine sodium (126 mEq/L) are consistent with SIADH, which leads to water retention and dilutional hyponatremia.

🧪The normal ANC and elevated WBC suggest no neutropenic infection, and other labs do not support adrenal or pituitary disorders.

🌊SIADH is commonly associated with small cell lung cancer and the paraneoplastic syndrome it induces.

🩺Adrenal insufficiency would show low sodium too but usually with high potassium, which is not seen here.

📌Core Message

SIADH causes dilutional hyponatremia and is common in small cell lung cancer.

Answer 2

Correct Answers:

"Here are the phone numbers and meeting locations for Alcoholics Anonymous and SMART Recovery."

Rationale :

📚Referring the client to community support groups like AA and SMART Recovery empowers self-management of sobriety.

🔄These groups offer peer support, which is critical in maintaining recovery from addiction.

🤝Although involving family and PCPs can help, they are not substitutes for community-based recovery support.

🎯This answer directly responds to the client’s request and supports autonomy.

📌Core Message

Connect clients to community support groups like AA to help maintain sobriety.

Answer 3

Correct Answers:

Social worker

Rationale :

🏠A social worker can assess the client's living situation, connect them to home assistance, and support services.

🧼Poor hygiene in an elderly person living alone may indicate functional decline or lack of resources, not necessarily abuse.

📋Adult Protective Services is only needed if there’s abuse or neglect—which hasn’t been established yet.

🧠Psychologists handle mental health concerns but are not the first referral for hygiene or environmental safety.

📌Core Message

Refer elderly clients with poor hygiene to a social worker for supportive services and assessment.

Answer 4

Correct Answers:

C

Rationale :

👶By 2 days postpartum, the fundus of the uterus should be located 1–2 fingerbreadths below the umbilicus, which corresponds to label C in the image.

📉This reflects normal involution, where the uterus shrinks back into the pelvic cavity after birth.

🩺Label A and B are too high, suggesting either immediate postpartum or abnormal uterine positioning (e.g., due to bladder distention or subinvolution).

📍Label D is too low, not consistent with the normal uterine height just 48 hours after delivery.

📌Core Message

On day 2 postpartum, the fundus is typically found just below the umbilicus, as shown by label C.

Answer 5

Correct Answers:

sense of impending doom

Rationale :

😰Free-floating anxiety often presents with intense dread or a sense of impending doom, even without a specific trigger.

📉This is a hallmark of severe or panic-level anxiety, distinguished from general worry or repetitive behaviors.

🔄Fear of what happens next is more typical of moderate anxiety, while repetitive behavior links to OCD, not anxiety alone.

🧠Understanding this helps in identifying severity and treatment strategies.

📌Core Message

A sense of impending doom is characteristic of severe free-floating anxiety.

Answer 6

Correct Answers:

Check the client’s activated partial thromboplastin time (aPTT) values daily to monitor for therapeutic anticoagulation.

Rationale :

🧪aPTT is used to monitor the effectiveness and safety of IV heparin therapy, ensuring it stays within a therapeutic range.

🛡️This prevents bleeding or clot progression and allows for dose adjustments.

🚫Vitamin K is the antidote for warfarin, not heparin; protamine sulfate is the correct antidote for heparin.

💡Heparin does not need light protection, and IV meds can usually share lines with proper flushing.

📌Core Message

Use aPTT monitoring to ensure therapeutic anticoagulation during IV heparin therapy.

Answer 7

Correct Answers:

aspirin.

Rationale :

❌Aspirin is linked to Reye’s syndrome, a potentially fatal condition when given during viral illnesses like flu or varicella.

🧠Reye’s syndrome causes liver damage and encephalopathy in children.

🌡️Acetaminophen (Tylenol) is the preferred antipyretic for children with viral symptoms.

💊Antihistamines and cough meds are not directly associated with Reye’s.

📌Core Message

Avoid aspirin in children with viral illnesses to prevent Reye’s syndrome.

Answer 8

Correct Answers:

Ensure frequently used items are within the client’s reach.
Encourage the use of grab bars in the bathroom.
Apply non-skid socks to the client.
Clear a path from the client’s bed to the bathroom.
Turn the client’s bed alarm on.

Rationale :

🛏️Non-skid socks, bed alarms, and clear paths all help reduce fall risk in elderly patients.

🚽Grab bars support safe bathroom use, and reaching items easily reduces overexertion.

❌Discouraging mobility can increase deconditioning and is not recommended unless unsafe.

📉These interventions create a safe environment for at-risk clients, especially those who live alone.

📌Core Message

Use environmental modifications and safety tools to reduce fall risk in elderly patients.

Answer 9

Correct Answers:

Avoid medical jargon.
Ensure client understanding throughout the conversation.

Rationale :

🗣️Avoiding medical jargon ensures the client can understand clearly through the interpreter.

👂Checking for understanding ensures that cultural and language barriers don’t interfere with safe care.

👁️Speak directly to the client, not the interpreter, and avoid loud or exaggerated speech.

💬One question at a time improves clarity and accuracy during interpretation.

📌Core Message

Promote culturally competent care by using clear language and ensuring understanding through the interpreter.

Answer 10

Correct Answers

Recent widow status [ Stressor ]
Inability to drive [ Stressor ; Care Barrier ]
Newly diagnosed glioblastoma multiforme [ Stressor ; Care Barrier ]
Limited English proficiency [ Care Barrier ]

Rationale :

💬Recent widowhood affects emotional state—stressor.

🚗Driving loss and brain tumor affect independence and care access.

🌐Language barrier limits communication with providers, making it a care barrier.

📌Core Message

Life events may be stressors, barriers, or both, impacting care access and family dynamics.

Laboratory Test and Reference Range
Hemoglobin (Reference range: <5.0 mg/dL)	10.6 g/dL
Hematocrit (Reference range: Female: 37%–47%; male: 42%–50%)	32%
Platelet count (Reference range: 150,000–450,000 mm³)	385,000/mm3
White blood cell (Reference range: 4,500–11,000 mm³)	19,100/mm3
Absolute neutrophil count (ANC) (Reference range: 2,000–8,250 million/mcL)	4,500 million/mcL
Sodium (Reference Range: 136–145 mEq/L)	126 mEq/L
Potassium (Reference Range: 3.5–5.0 mEq/L)	3.3 mEq/L
Chloride, serum (Reference Range: 98–106 mEq/L)	84 mEq/L
Bicarbonate (Reference Range: 23–28 mEq/L)	23 mEq/L
Glucose, plasma (Reference Range: 70–99 mg/dL)	127 mg/dL
Blood urea nitrogen (BUN) (Reference Range: 8–20 mg/dL)	8 mg/dL
Creatinine, serum (Reference Range: Female: 0.50–1.10 mg/dL; male: 0.70–1.30 mg/dL)	0.54 mg/dL
Calcium, serum (Reference Range: 8.6–10.2 mg/dL)	8.8 mg/dL
Phosphorus, serum (Reference Range: 3.0–4.5 mg/dL)	3.4 mg/dL
Uric acid, serum (Reference Range: 3.0–7.0 mg/dL)	2 mg/dL
Thyroid-stimulating hormone (TSH), serum (Reference Range: 0.5–4.0 mU/L)	3.5 mU/L
Osmolality, serum (Reference Range: 275–295 mOsm/kg H2O)	268 mOsm/kg H2O
Osmolality, urine (Reference Range: 38–1400 mOsm/kg H2O)	626 mOsm/kg H2O
Urine sodium (Reference Range: 40–220 mEq/day)	126 mEq/L

Body System	Findings
Neurological	Client is alert and cooperative with care. He has a flat affect. He is oriented to person, place, and time. Intact recent and remote memory. Thought processes are coherent. Judgment and insight are good.
Pulmonary	He has an intermittent dry cough. Shortness of breath is observed with exertion only. He has diminished lung sounds in bilateral lower lobes but clear to auscultation in all other lobes. Thorax is symmetric with good excursion. No wheezing, stridor, rhonchi, or rales noted.
Endocrine	Not assessed
Psychosocial	Client reports having been alone at home the past week since wife died 2 weeks ago. His only son moved to a new house a 3-hour drive away from him last year for work and is frequently on overseas business trips. Client declines the need for a home caregiver but states he is newly diagnosed with glioblastoma multiforme and now advised to not drive. He tripped and fell this morning after retrieving a newspaper in the front yard.

Factor	Stressor	Care Barrier
Recent widow status
Inability to drive
Newly diagnosed glioblastoma multiforme
Limited English proficiency

1 :
Use the table below to answer questions 1 to 3.
The nurse is reviewing laboratory values of a 52-year-old male client who recently completed his first cycle of chemotherapy infusion for small cell lung cancer treatment.

Answer Options

2 :
Question 2 of 3.
A nurse is working in an alcohol rehabilitation facility. A client she is caring for asks for a referral to a support group in the community that can help him maintain his sobriety. How should the nurse respond?

3 :
Question 3 of 3.
A nurse is caring for an elderly client who lives alone. Upon assessment, the nurse notes that the client has poor hygiene. Which is the most appropriate referral for this client?

4 :
A nurse is performing a fundal assessment on a client two days after delivery. Where in the abdomen would the nurse expect the fundal height to be located?

5 :
A nurse is caring for a client with free-floating anxiety. Which of the following symptoms would the nurse expect the client to exhibit?

6 :
A client is receiving intravenous (IV) heparin for treatment of deep vein thrombosis (DVT). Which of the following precautions should the nurse incorporate into the client’s plan of care as a result of receiving IV heparin?

7 :
The parent of a preschooler contacts the physician’s office to inquire about her child’s flu-like symptoms. The nurse knows that to decrease the risk for Reye’s syndrome, a child with flu-like symptoms or chickenpox should not be given:

8 :
Use the below EMT report to answer questions 8 and 9.
The nurse is caring for a 71-year-old male Cantonese-only speaking client who is brought to the emergency department (ED) by ambulance.

Answer Options

9 :
Question 9.
The Cantonese-speaking interpreter from the hospital interpreter services arrives at the client’s bedside. Which of the following actions should the nurse take to ensure culturally competent care for the client? Select all that apply.

Correct Answers

1 : Use the table below to answer questions 1 to 3.The nurse is reviewing laboratory values of a 52-year-old male client who recently completed his first cycle of chemotherapy infusion for small cell lung cancer treatment.

Answer Options

2 : Question 2 of 3.A nurse is working in an alcohol rehabilitation facility. A client she is caring for asks for a referral to a support group in the community that can help him maintain his sobriety. How should the nurse respond?

3 : Question 3 of 3.A nurse is caring for an elderly client who lives alone. Upon assessment, the nurse notes that the client has poor hygiene. Which is the most appropriate referral for this client?

4 : A nurse is performing a fundal assessment on a client two days after delivery. Where in the abdomen would the nurse expect the fundal height to be located?

5 : A nurse is caring for a client with free-floating anxiety. Which of the following symptoms would the nurse expect the client to exhibit?

6 : A client is receiving intravenous (IV) heparin for treatment of deep vein thrombosis (DVT). Which of the following precautions should the nurse incorporate into the client’s plan of care as a result of receiving IV heparin?

7 : The parent of a preschooler contacts the physician’s office to inquire about her child’s flu-like symptoms. The nurse knows that to decrease the risk for Reye’s syndrome, a child with flu-like symptoms or chickenpox should not be given:

8 : Use the below EMT report to answer questions 8 and 9.The nurse is caring for a 71-year-old male Cantonese-only speaking client who is brought to the emergency department (ED) by ambulance.

Answer Options

9 : Question 9.The Cantonese-speaking interpreter from the hospital interpreter services arrives at the client’s bedside. Which of the following actions should the nurse take to ensure culturally competent care for the client? Select all that apply.

Correct Answers

1 :
Use the table below to answer questions 1 to 3.
The nurse is reviewing laboratory values of a 52-year-old male client who recently completed his first cycle of chemotherapy infusion for small cell lung cancer treatment.

2 :
Question 2 of 3.
A nurse is working in an alcohol rehabilitation facility. A client she is caring for asks for a referral to a support group in the community that can help him maintain his sobriety. How should the nurse respond?

3 :
Question 3 of 3.
A nurse is caring for an elderly client who lives alone. Upon assessment, the nurse notes that the client has poor hygiene. Which is the most appropriate referral for this client?

4 :
A nurse is performing a fundal assessment on a client two days after delivery. Where in the abdomen would the nurse expect the fundal height to be located?

5 :
A nurse is caring for a client with free-floating anxiety. Which of the following symptoms would the nurse expect the client to exhibit?

6 :
A client is receiving intravenous (IV) heparin for treatment of deep vein thrombosis (DVT). Which of the following precautions should the nurse incorporate into the client’s plan of care as a result of receiving IV heparin?

7 :
The parent of a preschooler contacts the physician’s office to inquire about her child’s flu-like symptoms. The nurse knows that to decrease the risk for Reye’s syndrome, a child with flu-like symptoms or chickenpox should not be given:

8 :
Use the below EMT report to answer questions 8 and 9.
The nurse is caring for a 71-year-old male Cantonese-only speaking client who is brought to the emergency department (ED) by ambulance.

9 :
Question 9.
The Cantonese-speaking interpreter from the hospital interpreter services arrives at the client’s bedside. Which of the following actions should the nurse take to ensure culturally competent care for the client? Select all that apply.