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a nurse in a mobile health clinic is caring for a client who requires a tetanus immunization and is accompanied by his daughter. the client does not speak the same language as the nurse. which of the following actions should the nurse take?
- A. have the client’s daughter communicate information about the procedure
- B. arrange for a member of the client’s community to interpret the teaching
- C. identify the clients spoken dialect prior to contacting an interpreter
- D. use professional terminology when providing education prior to the procedure
Correct Answer: A
Rationale: The correct answer is A. The nurse should have the client's daughter communicate information about the procedure since she is accompanying the client and can facilitate effective communication. This option ensures that the client receives accurate information and instructions regarding the tetanus immunization. Choice B introduces a potential bias or misunderstanding if the community member is not trained in healthcare terminology. Choice C may delay the communication process unnecessarily. Choice D may confuse the client further due to the language barrier. It is essential to involve a trusted family member or caregiver for accurate and clear communication.
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a school nurse is implementing health screening. which of the following assessment finding should the nurse recognize as the highest priority?
- A. a child who has a BMI of 18
- B. an adolescent who has scoliosis
- C. an adolescent who has psoriasis
- D. a child who has nits
Correct Answer: B
Rationale: The correct answer is B: an adolescent who has scoliosis. Scoliosis is a condition where the spine curves abnormally, potentially leading to serious health issues if not addressed early. The nurse must prioritize assessing scoliosis as it can affect the individual's posture, mobility, and even breathing. BMI of 18 (choice A) may indicate underweight but doesn't pose an immediate health threat. Psoriasis (choice C) is a skin condition that, while uncomfortable, is not life-threatening. Nits (choice D) are treatable and not urgent.
a home health nurse is caring for a client who has chemotherapy induced nausea that has been resistant to relief form pharmacological measures. which of the following interventions should the nurse initiate (select all that apply)?
- A. use seasonings to enhance the flavor of foods
- B. provide sips of room temperature ginger ale between meals
- C. maintain the head of theclients bed in an elevated position after eating
- D. offer 120 ml (4 oz.) of cold 2% milk as a meal replacement
- E. assist the client in using guided imagery
Correct Answer: D
Rationale: The correct answer is D: offer 120 ml (4 oz.) of cold 2% milk as a meal replacement. Cold milk can help soothe the stomach and provide some relief from nausea. It is important to offer a small amount like 120 ml to prevent overwhelming the digestive system.
A: Using seasonings may worsen nausea due to strong flavors.
B: Ginger ale can contain carbonation which may exacerbate nausea.
C: Elevating the head of the bed is more beneficial for GERD, not chemotherapy-induced nausea.
E: Guided imagery may be helpful for relaxation but may not directly address the nausea.
In summary, offering a small amount of cold milk is the most appropriate intervention as it can help provide relief without exacerbating the nausea.
a nurse working in an infectious disease clinic is caring for a client has a new diagnosis of Lyme disease. which of the following agencies is responsible for voluntarily reporting cases of this disease to the centers for disease control and prevention
- A. office of the surgeon general
- B. state health department
- C. hospital infection control department
- D. local red cross chapter
Correct Answer: A
Rationale: The correct answer is A: office of the surgeon general. The office of the surgeon general is responsible for overseeing public health initiatives, including the surveillance and reporting of infectious diseases like Lyme disease to the Centers for Disease Control and Prevention (CDC). The surgeon general plays a crucial role in coordinating efforts to monitor and control disease outbreaks at the national level. The state health department (choice B) focuses on local and state-level reporting, while the hospital infection control department (choice C) is responsible for internal infection control measures within healthcare facilities. The local Red Cross chapter (choice D) primarily deals with disaster relief and community support, not disease reporting.
a community health nurse is planning an educational program for a group of women who are postmenopausal. which of the following outcomes is appropriate for this program?
- A. clients will schedule bone density screening
- B. clients will arrange for mammograms every 3 years
- C. clients will start hormone replacement therapy
- D. clients will significantly decrease caloric intake
- E. a nurse is working with a care manager for a client who participates in a health maintenance organization. the nurse should identify that a health maintenance organization provides which of the following payment structures.
Correct Answer: C
Rationale: The correct answer is C: clients will start hormone replacement therapy. Postmenopausal women often experience hormonal imbalances that can lead to various health issues such as osteoporosis and heart disease. Hormone replacement therapy can help alleviate symptoms and reduce the risk of these conditions. Scheduling bone density screenings (A) is important but does not address the underlying hormonal changes. Mammograms (B) are essential for breast cancer screening but are not directly related to postmenopausal hormonal health. Significantly decreasing caloric intake (D) is not a suitable outcome for a program targeted at postmenopausal women's health. The question also includes unrelated information about a health maintenance organization (E), which is a distractor.
a first response team isworking at the location of a bombing incident. a nurse triaging a group of clients should give treatment priority to which of the following clients.
- A. a client who has superficial partial thickness burn injuries over 5% of his body
- B. a client who has a femur fracture with a 2+ pedal pulse
- C. a client who is ambulatory andexhibits manic behavior
- D. a client who has a rigid abdomen with manifestations of shock.
Correct Answer: C
Rationale: The correct answer is C: a client who is ambulatory and exhibits manic behavior. In a triage situation, priority should be given to clients who have the highest risk of deterioration or immediate life-threatening conditions. In this scenario, a client exhibiting manic behavior may be a sign of an underlying medical or psychological emergency that requires immediate attention to prevent harm to themselves or others. This client may be at risk of causing harm or disrupting the triage process, making it necessary to address their condition promptly. Clients with superficial burns, femur fractures with a pedal pulse, or rigid abdomen with shock manifestations are important to assess and treat, but they do not present an immediate threat to themselves or others like a client exhibiting manic behavior.