Galen NUR 265 (NUR265) Advanced Concepts of Medical-Surgical Nursing – Exam 4 Version 2 Review | Questions & Answers | Latest 2026–2027.

Complete Galen College of Nursing NUR 265 (NUR265) Advanced Concepts of Medical-Surgical Nursing – Exam 4 Version 2 Review featuring organized questions and answers for focused exam preparation. Useful as an additional Exam 4 version for reviewing key advanced medical-surgical nursing concepts and reinforcing high-yield course material. Latest updated for 2026–2027. 1. A nurse is assessing sleep patterns in a 74-year-old client who resides in an assisted living facility. Which of the following is a normal age-related change in sleep patterns that the nurse should expect in this client? A) Both the time spent in bed and the actual time spent asleep increase. B) The amount of deep non-REM stage sleep increases, while time in bed decreases. C) The time spent in bed decreases, and the actual time spent asleep increases. D) The time spent in bed increases, but the actual time spent asleep decreases. 2. An older adult client complains of restless nights and frequent waking. When teaching the client about age-related physiological changes during sleep, which statement should the nurse include? A) The amount of leg movement during sleep naturally increases throughout life. B) Nocturnal leg movements are only present in clients with diagnosed peripheral vascular disease. C) Older adults experience a complete absence of rapid eye movement (REM) cycles. D) Leg movement during sleep decreases with age as nerve conduction slows. 3. The nurse is providing education to an older adult client on non-pharmacological interventions to promote healthy sleep. Which instruction should the nurse include? A) Encourage maintaining a consistent sleep-wake cycle and minimizing daytime naps. B) Take a short 1-hour nap in the late afternoon to compensate for night waking. C) Engage in vigorous cycling or weightlifting right before bedtime to induce fatigue. D) Increase caffeine intake slightly in the evening to prevent early bedtime awakening. 4. The nurse is developing a plan of care to promote healthy sleep for an older adult client admitted to an acute care unit. Which nursing action is a priority? A) Encourage the client to participate in high-intensity exercise in the hallway before bedtime. B) Perform hourly vital sign checks and blood draws to monitor clinical status. C) Cluster nursing care at night to decrease noise and minimize sleep disruptions. D) Keep the room brightly lit throughout the night to promote the client's circadian rhythm. 5. The nurse in a long-term care facility is caring for a client with advanced Alzheimer's disease who is walking the hallways at night. Which action should the nurse take first? A) Instruct the client to return to bed and apply a bed alarm. B) Request a prescription for physical restraints to prevent wandering. C) Administer a prescribed PRN dose of zolpidem immediately. D) Assess the client for the presence of pain or discomfort. 6. What is the best nursing intervention to improve sleep quality for a client newly admitted to an assisted living facility or long-term care setting? A) Keep a television turned on in the client's room all night for white noise. B) Administer an over-the-counter sleep aid at 8:00 PM nightly. C) Encourage the client to carry out their normal bedtime routine that they have at home. D) Assess the client's cognitive function hourly throughout the night. 7. An older adult client presents to the clinic with complaints of persistent fatigue. Which set of symptoms reported during morning assessments should lead the nurse to suspect obstructive sleep apnea (OSA)? A) Ringing in the ears, daytime hyperactivity, and visual floaters. B) Leg numbness, morning hypertension, and peripheral edema. C) Morning headaches, complaints of morning insomnia, and daytime drowsiness. D) Coughing up pink frothy sputum, night sweats, and chest pain. 8. The nurse is caring for a client diagnosed with Restless Leg Syndrome (RLS). What is the primary underlying physiological mechanism that the nurse should associate with this condition? A) Ischemia to the legs. B) Peripheral microvascular thrombosis due to warfarin therapy. C) Loss of voluntary muscle atonia during dreaming. D) Excessive accumulation of calcium deposits in the joint cartilage. 9. A client is newly diagnosed with Restless Leg Syndrome (RLS). Which physiological risk factors and lifestyle habits should the nurse assess for? A) Hypercalcemia, low BMI, high-protein diet, and regular low-intensity exercise. B) Iron deficiency, end-stage renal disease (ESRD), diabetes, increased BMI, and caffeine, alcohol, or tobacco use. C) Vitamin A deficiency, hypotension, high-purine diet, and use of antihistamines. D) Pancytopenia, severe damage to the cardiac system, and a history of biological terrorism exposure. 10. The nurse is planning care for a client with Restless Leg Syndrome (RLS) who has difficulty falling asleep. Which interventions should the nurse include? A) Administer alendronate (Fosamax) at bedtime and instruct the client to lie flat. B) Apply cold compresses to the lower extremities and administer colchicine. C) Administer gabapentin before bedtime as prescribed and encourage lower extremity stretching techniques. D) Encourage 30 minutes of high-intensity bicycling right before bedtime. 11. The nurse is assessing a 62-year-old male client who presents with violent nocturnal dream enactment, including punching and kicking. Which sleep disorder should the nurse suspect? A) Circadian Rhythm Sleep Disorder (Advanced Sleep Phase Disorder). B) Rapid Eye Movement (REM) sleep behavior disorder. C) Obstructive Sleep Apnea (OSA). D) Restless Leg Syndrome (RLS). 12. A client with REM sleep behavior disorder is being discharged. Which pharmacological treatment and discharge teaching are critical for client safety? A) Prescription of alendronate and remaining upright for 30 to 60 minutes. B) Prescription of zolpidem and keeping a television on during the night. C) Prescription of clonazepam and implementation of home safety measures. D) Prescription of gabapentin and performing lower extremity stretches before bed. 13. A client is scheduled for an evaluation of sleep disturbances. What diagnostic tool should the nurse instruct the client to use for 2 to 3 weeks prior to evaluation? A) A sleep diary. B) A daily scale for recording morning blood pressure. C) A continuous pulse oximeter. D) An electroencephalogram (EEG) log. 14. Which of the following statements regarding Rapid Eye Movement (REM) sleep is correct based on physiological characteristics? A) REM sleep is highly associated with limb ischemia and restless leg movements. B) REM sleep is the longest phase of sleep in older adults and occurs immediately upon falling asleep. C) REM sleep is characterized by an increase in voluntary muscle atonia and is not linked to dreaming. D) REM sleep occurs within 90 minutes of sleep onset and is linked to dreaming and memory consolidation. 15. A client presents with low-grade fever, joint pain, frequently changes positions, and wakes up during the night. The nurse should recognize these signs as common clinical manifestations of which condition? A) Fibromyalgia Syndrome. B) Systemic Sclerosis (Scleroderma). C) Systemic Lupus Erythematosus. D) Osteoarthritis. 16. An older adult client is prescribed zolpidem at bedtime for transient insomnia. What is the priority nursing intervention after administering this medication? A) Implement safety measures, including bed and chair alarms, and place the call light within reach. B) Perform a complete neurological exam every 30 minutes to check for atonia. C) Encourage the client to perform light weights and stretch lower extremities. D) Ensure the patient remains in a high-Fowler's position for at least 1 hour. 17. To promote healthy sleep habits and reduce nocturnal sleep disturbances, what environmental and behavioral modifications should the nurse teach the client? A) Use earplugs, decrease lighting, keep consistent sleep times, and decrease caffeine and activity before bed. B) Engage in light weights exercise right before bed and keep a soft light on. C) Drink hot black tea before bed and perform leg stretches in the hallway. D) Administer zolpidem with a glass of warm milk and keep the television playing. 18. The nurse is instructing an older adult client on physical fitness guidelines to maintain mobility and cardiovascular health. What should the nurse recommend? A) 60 minutes of high-intensity running daily and 3 days of heavy weight training. B) 150 minutes of continuous swimming daily and no weight-bearing activity. C) 10 minutes of light stretching daily and avoiding any weight-bearing exercises. D) 30 minutes of bicycling for 5 days a week and 2 days of low impact weights, totaling 150 minutes over 7 days. 19. The nurse is reviewing the sleep history of several older adult clients. Which client is exhibiting internal risk factors for sleep disturbances? A) A client residing in a noisy room near the nursing station. B) A client who consumes alcohol before bedtime. C) A client with persistent joint pain and urinary frequency. D) A client taking multiple nighttime medications. 20. An older adult client is prescribed a sleep aid. Which pharmacological principle should the nurse apply to minimize adverse drug reactions in this population? A) Give the sleep aid with a stimulant to balance daytime drowsiness. B) Start with a low dose and slowly titrate up. C) Administer a full adult loading dose and then discontinue immediately. D) Avoid all sleep aids and rely solely on high-dose opioids for sleep induction. 21. A nurse is assessing an older adult's skin and notes extremely dry, cracked, and itchy skin. Which term should the nurse use to document this finding? A) Pruritus B) Scabies C) Xerosis D) Purpura 22. An older adult client presents to the clinic complaining of intense skin itching. What is the most appropriate initial action by the nurse? A) Listen to the client's complaint, perform a thorough skin assessment, and check for lesions. B) Apply a high-potency topical steroid immediately to the entire body. C) Instruct the client to avoid bathing and apply baby powder. D) Suggest that the client use a regular razor to scrape the itchy areas. 23. The nurse is providing discharge instructions to a client diagnosed with scabies. Which statement by the client indicates a correct understanding of the disease process? A) I should expect that the skin itching may continue for a few weeks after treatment. B) The itching will resolve completely within 24 hours of starting the treatment. C) I should apply a warm moist pack to the lesions to kill the mites. D) Scabies is a non-contagious skin condition caused by UV sun exposure. 24. An older adult client has several elevated, noncancerous lesions on the upper chest. The nurse should recognize these as which of the following? A) Seborrheic Keratoses B) Actinic Keratoses C) Herpes Zoster D) Squamous Cell Carcinoma 25. A client presents with rough, dry, scaly skin on the face and forearms. The client reports a history of significant sun exposure. The nurse should recognize these findings as consistent with which condition? A) Candidiasis B) Actinic Keratoses C) Seborrheic Keratoses D) Shingles 26. The nurse is assessing an older adult client who presents with painful, unilateral papulovesicles distributed along a dermatome on the chest. Which condition should the nurse suspect? A) Scabies B) Herpes Zoster (Shingles) C) Candidiasis D) Squamous Cell Carcinoma 27. The nurse notes irregular, white, flat to slightly raised areas on an erythematous base in the oral cavity of a client with AIDS. Which condition and nursing action are appropriate? A) Squamous Cell Carcinoma; prepare the client for an immediate surgical iridectomy. B) Seborrheic Keratosis; apply a topical cortisone cream to the lesions. C) Purpura; check the client's PTT levels and prepare to administer heparin. D) Candidiasis (thrush); instruct the client to rinse their mouth often with warm saline or saliva substitutes. 28. A client has red, irregular, scaly lesions on the nose. The nurse notes that this type of skin cancer can spread to the liver. Which skin cancer should the nurse document? A) Melanoma B) Squamous Cell Carcinoma C) Basal Cell Carcinoma D) Seborrheic Keratosis 29. The nurse notes that an older adult client has purple areas on the forearms and hands. What medication usage is a priority for the nurse to assess? A) Warfarin (Coumadin) B) Alendronate (Fosamax) C) Acetazolamide D) Gabapentin 30. Which of the following non-pharmacological protective measures is highly recommended to protect fragile skin from tears in older adults? A) Wearing protective sleeves on the extremities. B) Applying dry heat daily to the skin. C) Massaging bony prominences with heavy pressure. D) Applying standard cosmetics with excess drying powder. 31. The nurse identifies a reddened, intact area over a client's sacrum. Which action should the nurse take first? A) Massage the reddened area vigorously with a high-alcohol lotion. B) Reposition the client off the area and avoid massaging the reddened prominence. C) Apply an ice pack to constrict blood vessels and reduce localized edema. D) Request a prescription for a pressure-relieving mattress for a client with AIDS. 32. The nurse is managing care for an immobile client. To prevent pressure injuries, what is the standard repositioning frequency that the nurse must enforce? A) Reposition the patient at least every 2 hours and avoid keeping them in the same position all day. B) Reposition the patient once during each 12-hour nursing shift. C) Reposition the patient every 4 to 6 hours and apply protective sleeves. D) Keep the patient in a semi-Fowler's position all day to promote circulation. 33. Which laboratory values are most reliable for assessing a client's nutritional status related to pressure injury healing and prevention? A) Blood urea nitrogen (BUN) and serum creatinine. B) Platelet count and activated partial thromboplastin time (aPTT). C) Serum potassium and sodium levels. D) Prealbumin or lymphocyte levels. 34. The nurse is caring for an older adult client with osteoarthritis (OA). Which exercise of choice should the nurse recommend to relieve joint pain? A) High-impact weightlifting B) Bicycling on an outdoor trail C) Swimming D) Strenuous competitive running 35. A client with osteoarthritis describes their joint pain as worst in the evening. How should the nurse schedule this client's clinic appointments to optimize their mobility? A) Schedule appointments in the evening when pain is highest. B) Schedule appointments in the late afternoon. C) Schedule appointments early in the morning. D) Schedule appointments during the night to promote sleep. 36. What is the primary underlying cause of pain and stiffness in a client diagnosed with osteoarthritis? A) Severe systemic ischemia resulting from low blood pressure. B) Cartilage wear leading to bone-on-bone contact. C) Autoimmune systemic inflammation of connective tissue. D) Accumulation of monosodium urate crystals in the joint spaces. 37. A client with rheumatoid arthritis (RA) describes their joint pain and stiffness as worst in the morning. When should the nurse schedule this client's physical therapy appointments? A) Schedule appointments in the late afternoon. B) Instruct the client to avoid all physical therapy appointments. C) Schedule appointments right before sleep at night. D) Schedule appointments early in the morning. 38. The nurse is assessing a client with rheumatoid arthritis (RA). Which systemic clinical manifestations should the nurse expect to find in this client? A) Macular rash on the chest and severe hypertension. B) Fatigue, low-grade fevers, anorexia, and weight loss. C) Urinary retention, bounding pulses, and a shuffling gait. D) High-grade fever, facial edema, and diarrhea. 39. The nurse is educating a client on joint protection and thermal therapy for arthritis. Which thermal therapy choices are correct for osteoarthritis (OA) and rheumatoid arthritis (RA)? A) Vigorous massage and heat therapy for both conditions. B) Cold therapy for Osteoarthritis and heat therapy for Rheumatoid Arthritis. C) Acupuncture for Osteoarthritis and cold therapy for Rheumatoid Arthritis. D) Heat therapy for Osteoarthritis and cold therapy for Rheumatoid Arthritis. 40. The nurse is taking a health history from a client with a history of acute gout flare-ups. Which risk factors should the nurse identify as contributing to gout? A) Low-purine diet, hypotension, and regular low-intensity walking. B) Low BMI, chronic exposure to cold, and history of penicillin allergy. C) High-protein diet, use of corticosteroids, and vitamin A deficiency. D) Alcohol abuse, hypertension, high-purine diet, and certain medications. 41. A client presents with an acute, extremely painful gout flare-up in the great toe. Which medication should the nurse anticipate administering first for rapid pain control? A) Duloxetine B) Alendronate C) Colchicine D) Allopurinol 42. The nurse is planning a screening schedule for a postmenopausal client at risk for osteoporosis. How frequently should a dual-energy X-ray absorptiometry (DEXA) scan be scheduled? A) Every 2 years. B) Every 6 months. C) Only after a hip fracture occurs. D) Annually. 43. The nurse is reviewing the DEXA scan results of an older female client which indicate severe osteoporosis. The client has kyphosis. The nurse knows that this curvature of the spine is associated with which risk factor? A) High impact weight training. B) Chronic use of non-steroidal anti-inflammatory drugs. C) Low body mass index (BMI). D) High-protein diet. 44. A client is prescribed alendronate (Fosamax) for osteoporosis. Which critical administration instructions must the nurse provide to prevent severe gastric irritation? A) Take the medication right before bedtime and lie flat immediately. B) Take the medication with a full glass of water and sit upright for 30 to 60 minutes after taking it. C) Crush the tablet and take it with an antacid containing calcium. D) Take the medication with a high-protein meal or animal fat. 45. The nurse is developing an exercise plan for a client with osteoporosis to help slow bone loss. Which exercise should the nurse recommend? A) Swimming in a heated pool. B) Brisk walking with light weights. C) Passive range-of-motion stretching in a chair. D) High-impact running on hard pavement. 46. The nurse is reviewing the medication history of a client scheduled for an osteoporosis evaluation. Which medication class is a major risk factor for developing secondary osteoporosis? A) Antihistamines B) Non-steroidal anti-inflammatory drugs (NSAIDs) C) Steroids (Corticosteroids) D) Angiotensin-converting enzyme (ACE) inhibitors 47. An older adult client is taking warfarin. The nurse notes purple-colored areas over the client's extremities. What physiological finding does this represent? A) Xerosis B) Candidiasis C) Purpura D) Pruritus 48. The nurse is assessing a client with a history of severe sun exposure. Which non-melanoma skin lesion is described as a red, irregular, scaly lesion that can spread to the liver? A) Actinic keratosis B) Squamous cell carcinoma C) Seborrheic keratosis D) Herpes zoster 49. The nurse is managing a client's care. What are the key elements of non-pharmacological skin protection to reduce injury and skin tears in older adults? A) Applying dry heat, using standard soap twice a week, and keeping the bed flat. B) Using protective sleeves, repositioning every 2 hours, and maintaining adequate hydration. C) Applying heavy powder to folds, limiting fluid intake, and using restraints. D) Massaging reddened areas, applying ice packs, and using electric razors. 50. During a routine shift assessment of a client with osteoarthritis, the nurse notes a low-grade fever and joint pain. Which laboratory test should the nurse anticipate? A) Serum amylase level. B) Prostatic-specific antigen (PSA) level. C) Activated partial thromboplastin time (aPTT). D) White blood cell (WBC) count. 51. A nurse is performing a pain assessment on a client. Which physiological vital signs should the nurse assess as indicators of pain? A) Central venous pressure and wedge pressure. B) Respiratory rate and urine output. C) Temperature and oxygen saturation. D) Blood pressure and pulse. 52. The nurse is preparing to assess the pain level of a client from a European or Asian cultural background. Which pain scale is most appropriate? A) Visual Analog Scale. B) Numerical Rating Scale (0-10). C) FLACC Pain Scale. D) Wong-Baker FACES scale. 53. The nurse is choosing a pain assessment scale for an older adult client. Which nursing action is a priority before selecting and using the scale? A) Assess the patient and their cognitive function. B) Administer a low dose of an opioid to establish a baseline. C) Check the client's prealbumin and lymphocyte levels. D) Ask the physician which scale is preferred for the unit. 54. A stroke patient with expressive aphasia is exhibiting restlessness. How should the nurse assess this client's pain? A) Wait for a family member to arrive and describe the pain. B) Notice verbal cues and body language. C) Insist that the client use the Wong-Baker FACES scale. D) Perform a sensory test with hot and cold liquids. 55. An older adult client with decreased mobility is admitted to the medical unit. What is the primary goal of nursing care related to this client's immobility? A) Implementing physical restraints to prevent accidental falls. B) Pain management and decreasing blood clotting from not moving. C) Promoting deep sleep cycles using high-dose zolpidem. D) Enforcing a strict high-fat diet with low fluid intake. 56. The nurse is performing a pain assessment on a client. The client rates their pain as a 9 out of 10, but is smiling and talking on the phone. What should the nurse do? A) Re-assess the client's cognitive function using the Wong-Baker FACES scale. B) Document the exact rating the patient says no matter what. C) Refuse to administer any pain medication because the client is smiling. D) Document the pain as a 3 out of 10 based on clinical observation. 57. A client is interested in non-pharmacological interventions for chronic lower back pain. Which therapy involves tiny needles inserted along specific meridians in the body? A) Acupuncture B) Acupressure C) Biofeedback D) TENS (transcutaneous electrical nerve stimulation) 58. Which non-pharmacological strategy teaches an individual to learn voluntary control over some body processes and alter them by changing physiological correlates? A) Distraction B) Biofeedback C) Guided imagery D) Acupressure 59. A client is experiencing intense localized pain during a dressing change. The nurse encourages the client to talk about their recent vacation. Which behavioral strategy is the nurse using? A) Acupuncture B) Guided imagery C) Biofeedback D) Distraction 60. What is a highly effective, client-centered intervention to assist with pain management for a client who is hospitalized in an unfamiliar environment? A) Isolate the client in a quiet room and restrict all visitors. B) Administer a routine around-the-clock dose of an opioid. C) Keep the room brightly lit and play loud background music. D) Always ask the family to bring in comforts from home. 61. What is the primary rule of pharmacological pain management in older adults? A) Start with a high loading dose, then taper off rapidly. B) Avoid all opioids due to the extreme risk of addiction. C) Rely solely on non-pharmacological interventions first. D) Start low, go slow, but go! 62. The nurse is reviewing the safety profile of non-steroidal anti-inflammatory drugs (NSAIDs) for chronic pain management. What are the major risks associated with chronic non-opioid NSAID use? A) Dizziness, sedation, falls, pruritus, constipation, and severe respiratory depression. B) Myocardial infarction, strokes, nausea, abdominal pain, GERD, and GI bleeding presenting with dark tarry stools. C) Pancytopenia, severe damage to the visual cortex, and a rapid drop in CD4 counts. D) Urinary retention, hypercalcemia, low BMI, and extreme hypertension. 63. The nurse is preparing to administer an opioid analgesic to an older adult client. What are the key risk factors and side effects that the nurse must monitor for? A) Dark tarry stools, myocardial infarction, strokes, and esophageal dysmotility. B) Dizziness, sedation, falls, nausea, pruritus, and constipation. C) Widespread hives, hypercalcemia, and metabolic acidosis. D) Loss of central vision, yellow-tinged sputum, and severe hypertension. 64. Which clinical assessment is absolutely crucial for the nurse to perform regularly when caring for an older adult receiving opioid therapy? A) DEXA scan results B) Respiratory rate C) Urinary specific gravity D) Prealbumin levels 65. An older adult client with chronic pain refuses to take prescribed pain medication before family visits because they want to stay awake and alert. Which action should the nurse take? A) Apply a bed alarm and restrict the patient from speaking with visitors. B) Explain that pain medication is mandatory and restrict the family's visit. C) Hold the medication as requested, or consult the provider for a lower dosage or different pain medication. D) Administer the medication covertly in the client's food before the family arrives. 66. The nurse is assessing several older adult clients on a medical-surgical unit. Which client has a gait disturbance that indicates a high risk for falling? A) A client with a shuffling gait. B) A client who uses a cane with a smooth, rhythmic gait. C) A client with a steady, wide-based gait. D) A client who stands up slowly from a sitting position. 67. What is the primary physiological reason that older adults who fall sideways often sustain hip fractures? A) Sideways falls cause a sudden drop in serum calcium levels, leading to instant bone lysis. B) The impact of a sideways fall causes severe metabolic acidosis in the femur. C) They fall directly on the side of the hip where there is less protective tissue. D) They fall sideways due to a severe, unilateral detached retina. 68. Which of the following is considered an intrinsic risk factor for falls in an older adult client? A) Poor lighting and inappropriate footwear. B) Lack of support equipment in the bathtub and at the toilet. C) Reduced hearing and vision, unsteady gait, cognitive impairment, and acute or chronic illnesses. D) Improper height of the bed and floor conditions. 69. The nurse is choosing a fall risk assessment tool for use in a long-term care facility. Which tool is correct based on clinical validation? A) Hendrich's II Fall Risk Scale should be used, as the Morse Fall Scale is not validated for long-term care. B) A DEXA scan should be performed every 6 months to assess fall risk. C) Wong-Baker FACES scale is the primary fall risk assessment tool. D) The Morse Fall Scale should be used for all long-term care residents. 70. The nurse is reviewing the use of side rails on a client's bed. Which configuration is considered a physical restraint and requires a physician's order? A) Two full-length side rails or four half-length side rails. B) Two half-length side rails on the upper portion of the bed. C) One half-length side rail on the upper portion of the bed. D) A low-bed configuration with no side rails. 71. A client presents with complaints of visual glare, halos around lights, and poor night vision. During assessment, the nurse notes a red reflex that appears black. Which condition should the nurse suspect? A) Macular Degeneration B) Primary Open-Angle Glaucoma C) Cataracts D) Detached Retina 72. The nurse is providing discharge education to a client who underwent cataract surgery. Which physical activity restrictions should the nurse emphasize? A) Perform light weights exercises and lower extremity stretching. B) No heavy lifting, straining, or bending at the waist. C) Engage in 30 minutes of low-intensity bicycling immediately. D) Shower daily and avoid any protective sunglasses. 73. A client who had cataract surgery yesterday calls the clinic reporting moderate to severe pain, scratchiness, and eye discharge. What is the nurse's priority action? A) Explain that these are normal expected findings on the first post-operative day. B) Instruct the client to use artificial tears or saline gel every 2 hours. C) Instruct the client to notify the surgeon immediately. D) Advise the client to apply a warm compress and take an over-the-counter NSAID. 74. An older adult client is diagnosed with Primary Open-Angle Glaucoma. Which clinical manifestations should the nurse expect? A) Floaters, black dots, and lines across the front of the eye. B) A curtain coming down over the entire visual field and sudden blindness. C) Loss of peripheral vision, eye aches, headaches, and poor vision in dim lighting. D) Loss of central vision, blurry spot in the middle, and severe eye discharge. 75. A client is diagnosed with Angle-Closure Glaucoma. The nurse should recognize this as which of the following? A) A medical emergency requiring an immediate iridectomy. B) A slowly progressive, non-emergent condition treated with daily artificial tears. C) A reversible conductive visual impairment caused by cerumen accumulation. D) A condition that requires immediate treatment with antihistamines and vasodilators. 76. A client is diagnosed with angle-closure glaucoma. Which class of medications is strictly contraindicated for this client? A) Carbonic anhydrase inhibitors and beta-blockers. B) Antihistamines, stimulants, and vasodilators. C) Non-steroidal anti-inflammatory drugs and Tylenol. D) Calcium channel blockers and ACE inhibitors. 77. A client with diabetes mellitus asks the nurse about symptoms of diabetic retinopathy. Which is a characteristic symptom, and what is the key teaching point? A) A curtain coming down over the eye; it is treated with high-dose corticosteroids. B) Painful unilateral papulovesicles; it is prevented with the Gardasil vaccine. C) A blurry spot in the middle of vision; it can be fully reversed with an immediate iridectomy. D) Floaters; once vision is affected, it is too late to reverse damage, so strict blood sugar control is essential. 78. An older adult client is diagnosed with Age-Related Macular Degeneration (AMD). Which visual change is characteristic of this condition, and what are the risk factors? A) Loss of peripheral vision with eye aches; risk factors include a high-purine diet and alcohol abuse. B) Loss of central vision presenting as a blurry spot in the middle; risk factors include age, genetics, obesity, and uncontrolled hypertension. C) Halos around lights and a black red reflex; risk factors include a history of shingles and chemotherapy. D) Sudden loss of entire vision with a curtain-like effect; risk factors include low BMI and a history of falls. 79. What dietary and lifestyle instructions should the nurse provide to help slow the progression of macular degeneration? A) Consume 3 to 5 liters of fluid daily and take high-dose NSAIDs. B) Avoid green vegetables and consume a diet high in purines and animal fat. C) Limit physical activity and avoid the use of sunglasses. D) Avoid smoking and eat a diet rich in dark green, leafy vegetables and fruits. 80. A client presents to the emergency department reporting a sensation like 'a curtain is coming down' over their vision, resulting in a sudden loss of sight. Which condition should the nurse suspect? A) Detached retina B) Advanced cataracts C) Diabetic macular edema D) Angle-closure glaucoma 81. A client is diagnosed with a detached retina. Which classes of home medications should the nurse instruct the client to avoid? A) NSAIDs, acetaminophen, and proton pump inhibitors. B) Antihistamines, diuretics, beta-blockers, and sleeping pills. C) Heparin, calcitonin, and high-dose corticosteroids. D) Penicillin, erythromycin, and general vaccinations. 82. A client complains of severe dry eyes. What vitamin deficiency is associated with this condition, and what are appropriate home management strategies? A) Vitamin B deficiency; take antihistamines and use a hair dryer to warm the eyes. B) Calcium deficiency; restrict fluids and avoid warm incandescent lighting. C) Vitamin D deficiency; apply warm dry compresses and use a regular razor. D) Vitamin A deficiency; utilize artificial tears or saline gel, use a home humidifier, and avoid wind and hair dryers. 83. The nurse is developing an environmental plan to enhance vision and safety for a visually impaired client. Which interventions should the nurse include? A) Install fluorescent lighting, move furniture weekly, use small print, and provide regular razors. B) Keep the room dimly lit, paint all doors white, and restrict the use of watches. C) Use warm incandescent lighting, protect from glare, use bold print on labels, use an analog clock for food placement, and do not move furniture. D) Provide reading materials with dark blue background and utilize standard scales. 84. A nurse is assessing a client for a potential hearing impairment. Which of the following client behaviors during an interview should indicate a hearing problem? A) The client nods their head frequently and answers questions immediately. B) The client complains of a burning sensation when drinking citrus juices. C) The client speaks very softly and looks directly at the nurse's hands. D) The client talks louder than the normal room level and turns their good ear towards the speaker. 85. An older adult client is diagnosed with a conductive hearing loss. What is a primary, potentially reversible cause of this type of hearing loss, and how does it differ from sensorineural loss? A) Vitamin B deficiency; sensorineural loss is treated with a simple surgical iridectomy. B) Noise exposure; sensorineural loss is fully reversible with hearing aids. C) Chronic middle ear infections; sensorineural loss is caused by otosclerosis. D) Otosclerosis or cerumen accumulation; sensorineural loss is non-reversible and caused by aging. 86. A client is diagnosed with tinnitus. How should the nurse explain this symptom to the client? A) A temporary loss of balance causing the client to fall sideways. B) A constant or intermittent ringing, buzzing, roaring, hissing, or whistling in the ears. C) A low-grade headache accompanied by severe facial and neck edema. D) A sensation that a curtain is coming down over the visual field. 87. The nurse is preparing to communicate with a client who has a significant hearing impairment. Which communication strategies should the nurse utilize? A) Exclude the patient from complex conversations and speak only to the family. B) Gain the individual's attention before speaking, ensure their hearing aid is in place with working batteries, do not cover the face or wear a mask, and use the teach-back method. C) Shout loudly from across the room and cover the mouth to prevent lip reading. D) Provide a pen and paper for the client to write all questions to avoid talking. 88. A client with human immunodeficiency virus (HIV) is prescribed combination antiretroviral therapy (cART). Which critical concept should the nurse teach the client regarding how this therapy works? A) cART is only taken when the client feels sick or has an active infection. B) cART only inhibits viral replication and does NOT kill the virus. C) cART is a curative therapy that completely eradicates the virus from the body. D) cART directly destroys mature circulating HIV particles in the bloodstream. 89. The nurse is reinforcing medication compliance teaching with an HIV-positive client on cART. What is the minimum required adherence rate to prevent drug resistance, and what should the nurse explain? A) The client must maintain 100% compliance for the first month, after which they can discontinue the drug. B) The client can miss up to 5 doses out of 10 without any risk of developing drug resistance. C) The client must take at least 50% of their doses on time to ensure the virus is killed. D) The client must take at least 90% of their doses on time because missed doses lower blood concentration below what is needed to inhibit viral replication. 90. An HIV-positive client is admitted to the emergency department with a productive cough, night sweats, chest pain, and shortness of breath. The client's CD4+ count is low. Which action should the nurse take next after initiating airborne precautions? A) Obtain a sputum culture for Pneumocystis jiroveci. B) Place the client on a pressure-relieving mattress. C) Check the client's temperature. D) Administer a dose of prescribed oral cART. 91. The newly hired nurse is developing a plan of care for a client who has acquired AIDS and was just diagnosed with Pneumocystis jiroveci pneumonia (PJP) and severe pain. Which intervention by the new nurse should the preceptor question? A) Administering prescribed opioid analgesics for pain control. B) Assessing the client's respiratory rate and oxygen saturation. C) Rinsing the mouth with warm saline or saliva substitutes. D) Placing the client on a pressure-relieving mattress. 92. A client with AIDS has just been diagnosed with cryptococcal meningitis. Which of the following priority actions should the nurse take? A) Apply a surgical mask to the client to initiate airborne precautions. B) Administer a live shingles vaccine to prevent viral reactivation. C) Initiate seizure precautions with padded side rails. D) Prepare to administer acetazolamide for altitude-related cerebral edema. 93. The community health nurse is instructing a group of clients with AIDS about infection prevention. Which of the following statements indicates the need for additional teaching? A) I will wear a surgical mask when I change my cat's litter box. B) I will avoid digging in the garden or working with houseplants. C) I will wash my hands immediately after handling my pet. D) I will clean my toothbrush weekly by running it through the dishwasher. 94. The nurse is precepting a newly hired nurse who is caring for an immunocompromised client with AIDS who has developed Kaposi's sarcoma skin lesions. Which action by the new nurse requires intervention by the preceptor? A) Cleanses the client's skin with a mild antimicrobial soap. B) Informs the client that make-up is acceptable to cover closed lesions. C) Assesses the lesions for weeping or open drainage. D) Applies a surgical mask before entering the client's room. 95. A client receives an immunization and is asked to wait in the clinic for 15 minutes. Five minutes later, the client develops sudden eye swelling, anxiety, shortness of breath, and dizziness. Which action must the nurse take first? A) Perform a respiratory assessment. B) Call the hospital incident commander. C) Obtain large-bore intravenous access. D) Administer IM epinephrine 0.3 mL. 96. A client is experiencing an acute, severe anaphylactic reaction. The nurse should anticipate administering epinephrine. What are the physiological mechanisms of epinephrine in anaphylaxis? A) Dilates blood vessels, decreases heart rate, and constricts the bronchioles. B) Constricts blood vessels, improves cardiac contraction, and dilates the bronchioles. C) Induces bicarbonate diuresis and causes a mild metabolic acidosis. D) Acts as an anti-inflammatory agent in the CNS to reduce cerebral edema. 97. A client is experiencing severe anaphylactic shock. What are the critical nursing actions that must be implemented immediately? A) Initiate oxygen via a nonrebreather mask, obtain large-bore IV access, administer IM epinephrine, and have a crash cart available. B) Check prealbumin levels, perform a colonoscopy, and apply a pressure-relieving mattress. C) Isolate the client in a negative pressure room and notify the CDC immediately. D) Administer oral acetaminophen, apply ice packs to the hands, and order a DEXA scan. 98. The newly hired nurse is reviewing the assessment findings of a client in anaphylaxis. Which clinical presentation is characteristic of severe anaphylaxis? A) Widespread hives and hypoxia. B) Bradycardia and standard hypertension. C) Unilateral papulovesicles and purpura. D) Clay-colored stools and dark urine. 99. A nurse is assessing a client with Systemic Lupus Erythematosus (SLE) and notes a dry, scaly, raised malar rash on the face. What major sign of an acute SLE exacerbation should the nurse monitor for? A) Urinary specific gravity of 1.005 B) Severe hypertension C) Epistaxis D) Fever 100. An older adult client with SLE is prescribed daily oral glucocorticoids. What is the best administration instruction the nurse should provide? A) Avoid taking the medication on consecutive days to prevent joint necrosis. B) Take the medication with an antacid containing calcium and lie flat for 1 hour. C) Take the medication with a high-protein meal right before bedtime. D) Take the steroid medication early in the morning before breakfast. 101. The nurse is providing discharge teaching to a client with Systemic Lupus Erythematosus (SLE) regarding skin care and lifestyle. Which statement by the client indicates a correct understanding? A) I will use standard cosmetics with excess drying powders to cover my rash. B) I will clean my skin with mild soap, pat it dry, apply lotion, and wear sunscreen when outdoors. C) I will use harsh highlights and chemical hair treatments to maintain my self-esteem. D) I should receive live vaccines annually to prevent opportunistic infections. 102. The nurse preceptor is observing a newly hired nurse care for a client who has Systemic Sclerosis (Scleroderma) and esophagitis. Which of the following actions by the newly hired nurse requires immediate intervention? A) Providing ice packs to the client's hands to help with joint pain. B) Instructing the client to avoid caffeine and cigarettes. C) Elevating the head of the bed to 60 degrees during and after meals. D) Assessing the client's ability to swallow semisoft foods. 103. The nurse is developing a dietary plan for a client with systemic sclerosis (scleroderma) who has esophageal dysmotility and esophagitis. Which intervention should the nurse include? A) Administer alendronate (Fosamax) right before meals and provide hot citrus juices. B) Encourage a liquid-only diet, keep the client flat during meals, and provide spicy foods to stimulate appetite. C) Instruct the client to drink large amounts of water between bites of solid dry foods and lie flat for 1 hour after eating. D) Provide small, frequent meals with semisoft foods, elevate the head of the bed to 60 degrees during and for at least an hour after meals, and use a thickener for liquids. 104. A client with systemic sclerosis (scleroderma) exhibits CREST syndrome. What does the 'E' in CREST represent, and what is its primary nursing implication? A) Epistaxis, which indicates a late-stage superior vena cava syndrome emergency. B) Esophageal dysmotility, which causes dysphagia and a high risk for choking. C) Erythematous base, which requires daily bathing with antimicrobial soaps. D) Elevated creatinine, which represents acute renal failure and a need for dialysis. 105. The nurse is assessing a client with Fibromyalgia Syndrome (FMS). Which symptoms should the nurse expect to find? A) Painful unilateral papulovesicles, low-grade fever, and a shuffling gait. B) Loss of peripheral vision, constant ringing in the ears, and dysphagia. C) Widespread hives, hypoxia, and acute abdominal pain. D) Widespread pain and stiffness in trigger points, fatigue, non-refreshing sleep due to lack of stage 4 sleep, and depression. 106. The nurse is preparing a discharge teaching plan for a client with fibromyalgia syndrome (FMS). Which non-pharmacological lifestyle intervention is highly effective in decreasing pain? A) High-impact weight training and running. B) Complete bed rest and immobilization of painful trigger points. C) Avoiding all stretching and performing daily dry heat massage. D) Low-intensity exercise, including stretching, walking, and swimming. 107. A client with fibromyalgia is prescribed amitriptyline (Elavil) at bedtime. What is the primary purpose of this medication in FMS, and what safety precaution is necessary for older adults? A) Promotes sleep and reduces pain or muscle spasm; use with caution due to risks of confusion and orthostatic hypotension. B) Provides an anti-malarial effect to decrease sun sensitivity; requires frequent eye exams. C) Directly inhibits viral replication; must be taken correctly 90% of the time. D) Causes bicarbonate diuresis and metabolic acidosis; monitor for a sulfa allergy. 108. A client with fibromyalgia complains of worsening fatigue and sleeplessness. Which dietary restriction should the nurse teach the client to improve sleep quality? A) Eliminate all red meat and wheat from the diet. B) Consume 3 to 5 liters of fluid and take aspirin daily. C) Avoid all dairy products and foods high in purine. D) Limit caffeine and alcohol, as they interfere with sleep. 109. A client presents with a red, flat rash with a clear center ('bulls-eye' lesion) on the upper thigh. The client reports a history of hiking in a wooded area 10 days ago. Which treatment does the nurse anticipate? A) Oral doxycycline for 14-21 days. B) IV ceftriaxone for 7 days followed by a live shingles vaccine. C) Oral ciprofloxacin for 60 days. D) Immediate surgical removal of the skin lesion. 110. A client with a confirmed tick bite is allergic to penicillin. What antibiotic should the nurse expect to be prescribed for early localized Lyme disease? A) Ceftriaxone B) Amoxicillin C) Erythromycin D) Colchicine 111. The nurse is teaching a group of park rangers about Lyme disease prevention and early detection. Which instruction should the nurse include? A) Avoid all vaccines and consume a diet high in purines to prevent infection. B) Apply dry heat or massage the tick bite area, and avoid any insect repellant containing DEET. C) Avoid dark clothing, wear long sleeves and pants tucked into boots, spray with DEET, and wait 4-6 weeks after a bite before testing. D) Wear dark clothing to attract ticks, use a regular razor to remove ticks, and get tested immediately after a bite. 112. The nurse is reviewing the medical records of several clients on the organ transplant waiting list. Which of the following is a strict contraindication to receiving an organ transplant? A) Age older than 65 with a functional social support system. B) A history of mild non-melanoma skin cancer. C) A history of controlled hypertension and atherosclerosis. D) Presence of active systemic infection, HIV/AIDS, active substance abuse, or malignant disease (except skin cancer). 113. The transplant coordinator is managing the transport of a donor kidney. What is the maximum viable time for a donor kidney outside the body, and what clinical expectation should the nurse have? A) 4 to 5 hours; the kidney must begin producing high-volume urine output within 10 minutes of reperfusion. B) 12 hours; the kidney must be flushed with warm crystalloids before surgical anastomosis. C) 48 to 72 hours; a 72-hour kidney will often require dialysis before it starts functioning on its own. D) 24 to 30 hours; the kidney will always function immediately and never require post-operative dialysis. 114. A client underwent a kidney transplant 24 hours ago. What are the clinical signs, timing, and treatment of hyperacute graft rejection? A) Occurs gradually over months, presenting with proteinuria; the treatment is plasmapheresis. B) Occurs within 1 week, presenting with oliguria; the treatment is to double the dosage of immunosuppressants. C) Occurs within 10 days, presenting with dark tarry stools; the treatment is immediate administration of heparin. D) Occurs within 48 hours, presenting with increased temperature, increased blood pressure, and pain at the transplant site; the treatment is immediate surgical removal of the kidney. 115. The nurse is caring for a client who is experiencing acute kidney transplant rejection. When did this likely occur, and what is the standard treatment? A) Occurs 1 week to anytime post-operatively; the treatment is to administer increased doses of immunosuppressive drugs. B) Occurs within 10 minutes of reperfusion; the treatment is immediate plasmapheresis. C) Occurs within 48 hours; the treatment is immediate surgical removal of the graft. D) Occurs gradually over several years; the treatment is conservative management until dialysis is required. 116. A client is 24 hours post-heart transplant. Which of the following findings is a priority for the nurse to report, as it indicates a serious complication? A) A ventricular rate of 95 beats per minute. B) Mediastinal drainage of 100 mL/hour. C) Hypotension D) The presence of two unrelated P waves on the ECG. 117. The nurse is assessing a client who is 10 days post-lung transplant. Which finding is the highest priority for the nurse to report to the primary health care provider? A) Mild hoarseness when speaking. B) The development of yellow-tinged sputum. C) An oxygen saturation of 92% on room air. D) Pleural drainage that is slowly decreasing. 118. A client is 48 hours post-liver transplant. Which of the following sets of laboratory results is a priority for the nurse to report to the primary health care provider? A) An increase in aspartate aminotransferase (AST), along with prolonged prothrombin time (PT), increased INR, and elevated bilirubin. B) A platelet count of 250,000 and a white blood cell count of 8,000. C) An increasing serum protein level and a normal to slightly elevated glucose level. D) A normal potassium level and decreasing blood urea nitrogen (BUN). 119. The nurse is assessing a client who underwent a kidney transplant two weeks ago. Which finding is a priority and should be correlated to possible organ rejection? A) Urine output of 150 mL/hour. B) Mild discomfort at the incision site when turning. C) A temperature of 98.4°F. D) Blood pressure of 172/96 mmHg. 120. The nurse is caring for a client in the immediate post-operative period following a heart transplant. What is a unique physiological characteristic of the transplanted heart that the nurse must consider? A) The heart relies entirely on a permanent pacemaker, and isoproterenol is strictly contraindicated. B) The heart is denervated (disconnected from the autonomic nervous system) and is unresponsive to vagal stimulation; therefore, atropine, digoxin, and carotid sinus pressure will not work. C) The heart requires a continuous infusion of epinephrine to maintain a heart rate of 60 bpm. D) The heart is hyper-responsive to vagal tone, and atropine is the drug of choice for bradycardia. 121. Which of the following is a clinical indicator of adequate early graft function in a client who has just received a liver transplant? A) Anuria and severe encephalopathy. B) Increasing serum protein levels and normal to slightly elevated glucose levels. C) Decreasing bile drainage and increasing jaundice. D) Rising AST and ALT levels with high total bilirubin. 122. The nurse is monitoring a client post-liver transplant. Which assessment finding should lead the nurse to suspect the development of peritonitis? A) An increase in temperature, increased abdominal pain, distention, and rigidity. B) Diminished bile drainage and a rising AST level. C) Blood oozing from a central venous catheter. D) Mental status changes and flapping hand tremors. 123. A client is recovering from a kidney transplant. What is a critical rescue situation where the nurse must notify the surgeon immediately? A) The development of hypotension or excessive diuresis (urine output 500-1000 mL greater than intake over 12-24 hours). B) Mild tenderness over the graft site when the patient performs deep breathing. C) A gradual increase in urine specific gravity to 1.015. D) A high volume of urine output that matches fluid intake over a 24-hour period. 124. The nurse is caring for a client who received a simultaneous pancreas and kidney transplant. What is a key clinical concept regarding rejection of these transplanted organs? A) The old pancreas is removed, and a new one is placed in the pelvic cavity to prevent dehydration. B) Pancreatic problems always occur first, and a high blood sugar is the earliest sign of rejection. C) Kidney problems occur before pancreatic problems, and an increase in serum creatinine indicates rejection of both organs. D) Rejection of the pancreas is diagnosed solely by a sudden increase in urine amylase levels. 125. The nurse notes a sudden drop in urine amylase levels, a rapid increase in blood sugar, and gross hematuria in a client post-pancreas transplant. What complication should the nurse suspect? A) Pancreatic blood vessel thrombosis B) Acute renal failure C) Acute hyperacute graft rejection D) Chronic graft rejection 126. What is the leading cause of morbidity and mortality in clients following an organ transplant, and what should the nurse consider regarding clinical manifestations? A) Infection due to immunosuppression; clients may not exhibit the usual manifestations of infection (such as high-grade fever), and a low-grade fever or mental status change may be the only sign. B) Hyperacute rejection; it always presents with severe incisional hemorrhage and a standard rash. C) Post-transplant malignancy; it typically manifests with severe bone pain and leukopenia within the first month. D) Acute renal failure; it is characterized by massive diuresis and severe hypovolemia. 127. A post-transplant client is being discharged. Which of the following instructions must be included in the discharge teaching plan? A) Live vaccines should be administered every 6 months to prevent viral reactivation. B) The client can safely use over-the-counter herbal preparations and NSAIDs for pain control. C) Lifelong compliance with the complex immunosuppressive medication regimen is crucial, and latent infections (like TB or Herpes) can be reactivated. D) The client can stop taking immunosuppressive medications once the organ has stabilized after 6 months. 128. A client post-liver transplant exhibits signs of progressive liver failure. What is the definitive method used to diagnose acute or chronic organ rejection? A) Magnetic resonance cholangiopancreatography (MRCP) B) Organ biopsy C) Diagnostic peritoneal lavage D) Serum AST and ALT levels 129. A client is diagnosed with late, severe Lyme disease with joint involvement. What treatment does the nurse anticipate administering? A) IV antibiotics for 30 days (such as ceftriaxone or cefotaxime). B) Oral doxycycline for 7 days followed by a 60-day course of allopurinol. C) Oral erythromycin for 60 days and a live vaccine. D) Intra-joint steroid injections only, and avoiding all antibiotics. 130. A client has a confirmed tick bite. How long should the client wait before being tested for Lyme disease to ensure reliable results? A) Immediately (within 24 hours). B) At least 6 months. C) 1 week. D) 4 to 6 weeks. 131. A 40-year-old client with a family history of colon cancer presents for a routine physical. Which action should the nurse take first regarding colon cancer screening? A) Advise the client to avoid all aspirin and red meat for the next 10 years. B) Perform a fecal occult blood test immediately in the clinic. C) Instruct the client to schedule a routine colonoscopy at age 50. D) Inform the primary health care provider of the client's family history to discuss screening options. 132. The nurse is assessing clients for breast cancer risk. Which client possesses the highest risk for developing breast cancer? A) A 25-year-old female with early menarche who has three children. B) A 30-year-old African American female with a history of cervical HPV infection. C) A 64-year-old Jewish female who had her first child at age 38 and has the BRCA1 gene mutation. D) A 50-year-old male who has a history of physical activity and a low-fat diet. 133. The nurse is assessing a client suspected of having lung cancer. Which clinical finding is a common consistent sign of this diagnosis? A) A painful unilateral rash with papulovesicles. B) Morning insomnia and a shuffling gait. C) Clay-colored stools and dark urine. D) Reoccurring episodes of bronchitis, pneumonia, or pleural effusion. 134. The nurse is assessing clients for cervical cancer risk. Which of the following clients is at the greatest risk for developing cervical cancer? A) A 40-year-old Caucasian female who is nulliparous and has a history of diabetes. B) A 24-year-old African American female who was diagnosed with human papillomavirus (HPV) a year ago. C) A 19-year-old female who received the Gardasil vaccine before first sexual contact. D) A 50-year-old Jewish female who had her first child at age 20 and has a BRCA2 mutation. 135. A client is receiving a chemotherapeutic agent that has a high potential to cause alopecia. What supportive teaching should the nurse provide to help the client maintain self-esteem? A) Suggest that the client shave their head weekly to prevent the hair from falling out. B) Inform the client that hair usually grows back within 1 month after the chemotherapy is completed. C) Advise the client that hair loss is permanent and they should purchase a wig immediately. D) Instruct the client to wash their hair with a harsh soap and use highlights. 136. The nurse is observing an unlicensed assistive personnel (UAP) care for a client receiving sealed brachytherapy for cervical cancer. Which action by the UAP requires immediate intervention by the nurse? A) Limiting visitor time to 30 minutes per day and keeping them 6 feet away from the patient. B) Wearing a dosimeter badge and a lead apron while providing care. C) Saving all dressing and bed linens in the patient's room until the source is removed. D) Picking up a dislodged radioactive implant with gloved hands to place it in a lead container. 137. A client receiving IV chemotherapy on the oncology unit reports the sudden development of back pain and painful urination. Which complication should the nurse suspect? A) Cystitis or nephrotoxicity, requiring immediate evaluation. B) Spinal cord compression, requiring high-dose corticosteroids. C) Tumor Lysis Syndrome, requiring aggressive dextrose and insulin infusions. D) Late-stage Superior Vena Cava Syndrome, requiring a metal stent. 138. The nurse is reviewing laboratory results of clients receiving chemotherapy. Which of the following results is a priority to report to the primary health care provider? A) White blood cell count of 6,000. B) Serum creatinine of 0.8. C) Platelet count of 50,000. D) Hemoglobin level of 13.5. 139. The oncology nurse receives the change-of-shift report. Which client should the nurse see first? A) A 56-year-old client receiving chest radiation who has developed a pericardial friction rub. B) A 60-year-old client receiving sealed brachytherapy who has mild nausea. C) A 70-year-old client with advanced lung cancer who has a dry, harsh cough. D) A 45-year-old client receiving chemotherapy who has a platelet count of 120,000. 140. A client is diagnosed with advanced oral cancer and has undergone extensive surgery. Which of the following client statements indicates that the client has accepted their diagnosis? A) "I will rinse my mouth with a commercial alcohol-based mouthwash daily." B) "I would like some more information on oral cancer." C) "I do not need to look at my surgical incisions." D) "I will continue to smoke cigarettes because the damage is already done." 141. Which of the following hygiene and oral care interventions is correct for an immunocompromised oncology client undergoing chemotherapy? A) Bathe weekly with standard soap and use an alcohol-based mouthwash daily. B) Wash only the face and hands daily and avoid all oral care during the nadir. C) Bathe daily with an antimicrobial soap and rinse the mouth often with warm saline or saliva substitutes. D) Use lemon-glycerin swabs and rinse with commercial mouthwash every 2 hours. 142. A client with cancer is receiving scheduled analgesics for pain. The client reports a sudden, severe flare-up of pain (breakthrough pain) and is not scheduled for their next dose of scheduled analgesic for another two hours. Which action should the nurse take next? A) Administer a prescribed PRN analgesic. B) Increase the dose of the scheduled analgesic and administer it immediately. C) Inform the client that they must wait two hours for their scheduled dose. D) Apply a cold pack to the painful area and encourage guided imagery. 143. To qualify for hospice care, what is the required prognosis for a client, and what is the major focus of care? A) A prognosis of 2 years or less; the focus is on primary prevention and surgical cures. B) A prognosis of 6 months or less to live; the major focus is on quality of life and a peaceful death. C) A prognosis of 3 months or less; the focus is on cardiopulmonary resuscitation and invasive life-support. D) A prognosis of 12 months or less; the focus is on continuing active chemotherapy and radiation. 144. A client with cancer has undetected tumor lysis syndrome (TLS). Which life-threatening assessment finding should the nurse correlate to the TLS, and how is TLS primarily prevented and managed? A) Uncontrolled hemorrhage from non-intact skin (due to DIC); managed with heparin therapy. B) Cardiac dysfunction (due to severe hyperkalemia); prevented and managed with aggressive hydration. C) Seizures and confusion (due to severe hyponatremia); prevented with fluid restriction. D) Severe respiratory depression (due to hypercalcemia); prevented with high-dose calcitonin. 145. A client with cancer develops spinal cord compression. What is the priority treatment that the nurse should anticipate will be prescribed first to alleviate the client's symptoms? A) High-dose opioids and a cooling blanket. B) Immediate surgical removal of the tumor. C) High-dose corticosteroids given through an IV bolus. D) Aggressive IV hydration with normal saline. 146. The nurse is caring for a cancer client who has developed disseminated intravascular coagulation (DIC). Which finding requires immediate reporting to the primary health care provider? A) A platelet count of 150,000 and a normal fibrinogen level. B) A complaint of mild nausea and generalized fatigue. C) A blood pressure of 120/80 and a temperature of 98.6°F. D) Bleeding from the nose, IV catheter sites, and rectum. 147. The emergency department nurse is admitting an unaccompanied, disoriented 78-year-old client who exhibits right-sided weakness and an elevated temperature. Which action should the nurse take first to ensure safety and gather clinical history? A) Place the client on a cooling blanket with ice packs to the axillae. B) Perform a two-person search of the client's belongings for a list of medications and history. C) Perform a complete neurological exam using the Morse Fall Scale. D) Insert a large-bore IV and administer a broad-spectrum antibiotic. 148. The emergency department nurse is triaging a group of clients. Which client should the nurse categorize as emergent and see first? A) A client with a closed, displaced fracture of the left arm. B) A client presenting with difficulty swallowing and left-sided weakness. C) A client reporting a new onset of severe abdominal pain. D) An 81-year-old client who has a temperature of 101°F and a respiratory rate of 18. 149. The emergency department nurse is triaging clients involved in an industrial accident. Which client should the nurse categorize as emergent and see first? A) A client reporting severe abdominal pain and nausea. B) A client who is walking and has minor cuts and abrasions. C) A client with deviation of the trachea to the right. D) A client with an open fracture of the leg with distal pulses present. 150. A client is brought to the emergency department by emergency medical technicians (EMT). The client is unresponsive,