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A clinic nurse is assessing a client who has measles. Which of the following findings should the nurse expect?
- A. Koplik spots inside the mouth
- B. Persistent low-grade temperature
- C. Muscle aches and tenderness
- D. Rash confined to the trunk of the body
Correct Answer: A
Rationale: The correct answer is A: Koplik spots inside the mouth. These are small, white spots surrounded by a red ring that appear on the buccal mucosa. This finding is characteristic of measles and typically precedes the onset of the rash. Koplik spots are highly specific to measles and can aid in early diagnosis. Persistent low-grade temperature (B) and muscle aches and tenderness (C) are common symptoms of many viral illnesses, including measles, but they are not specific to measles. The rash associated with measles typically starts on the face and head before spreading to the trunk and extremities, so a rash confined to the trunk (D) would not be expected in measles.
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A school nurse is planning safety education for a group of adolescents. The nurse should give priority to which of the following topics as the leading cause of death for this age group?
- A. Sports injury prevention
- B. Motor vehicle safety
- C. Substance abuse prevention
- D. Gun safety
Correct Answer: B
Rationale: The correct answer is B: Motor vehicle safety. Adolescents are at a higher risk of motor vehicle accidents, making it the leading cause of death in this age group. This is due to factors like inexperience, risk-taking behaviors, and distractions while driving. Sports injury prevention (A) is important but not the leading cause of death. Substance abuse prevention (C) is significant but not the primary cause of death. Gun safety (D) is also crucial but not as prevalent as motor vehicle accidents.
A nurse is assessing a client with hyperemesis gravidarum. Which of the following findings should the nurse expect?
- A. Oliguria
- B. Diplopia
- C. Hypoglycemia
- D. Dizziness
Correct Answer: A
Rationale: The correct answer is A: Oliguria. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, leading to dehydration and electrolyte imbalances. Oliguria, decreased urine output, is expected due to dehydration. Diplopia (B) and dizziness (D) are not specific to hyperemesis gravidarum. Hypoglycemia (C) may occur due to poor oral intake but is not a defining feature.
A nurse is working with a community health care team to devise strategies for preventing violence in the community. Which of the following interventions is an example of tertiary prevention?
- A. Presenting community education programs about stress management
- B. Developing resources for victims of abuse
- C. Urging community leaders to make nonviolence a priority
- D. Assessing for risk factors of intimate partner abuse during health examinations
Correct Answer: B
Rationale: The correct answer is B: Developing resources for victims of abuse. Tertiary prevention focuses on minimizing the impact of established disease or injury. By providing resources for victims of abuse, the community health care team is helping to support those who have already experienced violence, thus reducing potential long-term consequences. Choices A, C, and D are examples of primary and secondary prevention strategies, which aim to prevent violence before it occurs or identify and intervene early in cases of violence. These interventions are important but do not fall under tertiary prevention.
A public health nurse is responding to a suspected anthrax exposure at a workplace. Which action should the nurse take?
- A. Alert the family members of coworkers about possible exposure to anthrax
- B. Place the employee under quarantine for 14 days
- C. Refer coworkers who might have been exposed to a provider for prophylactic antibiotics
- D. Instruct the client to wear a mask at work
Correct Answer: C
Rationale: The correct action for the public health nurse is to refer coworkers who might have been exposed to a provider for prophylactic antibiotics (Choice C). This is because prophylactic antibiotics can help prevent the development of anthrax infection after exposure. Alerting family members (Choice A) is unnecessary as the focus should be on the exposed individuals. Quarantine (Choice B) may not be necessary if the individuals receive prophylactic treatment. Instructing the client to wear a mask (Choice D) is not effective in preventing anthrax transmission.
Which of the following statements should the nurse include in teaching about meningococcal meningitis?
- A. Toothbrush should be placed beside the child's bed
- B. Household contacts will receive prophylactic antibiotics
- C. Transmission will be prevented because of herd immunity
- D. The child is most contagious after the rash develops
Correct Answer: B
Rationale: The correct answer is B: Household contacts will receive prophylactic antibiotics. This statement should be included in teaching about meningococcal meningitis because prophylactic antibiotics are recommended for close contacts to prevent the spread of the infection. This is crucial in preventing outbreaks and protecting others who may have been exposed.
A: Placing a toothbrush beside the child's bed is not relevant to preventing the spread of meningococcal meningitis.
C: Transmission prevention through herd immunity is not a reliable method for controlling the spread of meningococcal meningitis.
D: The child is most contagious before the rash develops, not after, making this statement incorrect.
In summary, teaching about prophylactic antibiotics for household contacts is essential in managing meningococcal meningitis, while the other options do not directly address prevention measures.