A male patient is prescribed estrogen as hormone treatment for cancer. Which assessment is most important for the nurse to perform for this patient?
a. Ask whether there has been a change in the level of sexual activity.
b. Compare breast size after therapy to that from before therapy.
c. Check for swelling and hard, cordlike veins in the legs.
d. Measure the patient's abdominal girth.
C
Using estrogen as hormone therapy for cancer increases the risk for developing blood clots and deep vein thrombosis. The nurse assesses the patient for this problem at every clinic visit and instructs him (or her) to perform daily assessment of the lower extremities for swelling, hard, cord-like veins, redness along the vein tract, and extremity pain.
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An elderly woman tells the nurse that she was successfully treated with phenelzine (Nardil) during a bout of severe depression in the 1970s
Her mood has been worsening in recent years as she has dealt with the death of her husband and functional declines. As a result, she has asked the nurse if her care provider is likely to prescribe this same drug. What fact should underlie the nurse's response to the patient? A) Cognitive behavioral therapy has been found to be more effective than MAO inhibitors, so they are rarely prescribed. B) In most situations, MAO inhibitors have been largely superseded by tricyclic antidepressants. C) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used. D) MAO inhibitors are rarely used because serum levels must be monitored with blood work every 2 weeks.
A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)
a. Clear drainage b. Bloody drainage at site c. Client reports headache d. Foul-smelling drainage e. Urine draining from site
A client with peptic ulcer disease complains of sharp mid-epigastric pain. Which assessment finding is most important to the care of this client?
A) Pain is relieved with food. B) Pain returns 1 hour after eating. C) Explosive diarrhea D) Rigid abdomen
The nurse is caring for a patient with no history of diabetes who has a new laboratory finding of a glycosylated hemoglobin (A1C) level of 6.0%. Which nursing diagnoses should receive priority for this patient?
1. Deficient Knowledge regarding disease process 2. Risk for Deficient Fluid Volume 3. Risk for Impaired Skin Integrity 4. Ineffective Tissue Perfusion