Nokea
Which pulse's absence may not be a significant finding when a patient is admitted to the hospital?
- A. Apical
- B. Radial
- C. Pedal
- D. Femoral
Correct Answer: C
Rationale: The absence of the pedal pulse may not be significant if the patient has poor peripheral circulation or if the healthcare provider is focused on other pulse points. The pedal pulse is often weaker and may not always be palpable due to various factors, making its absence less concerning in certain situations. However, the absence of other pulses like radial or femoral pulses may indicate more critical conditions and require immediate attention.
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Which of the following interventions is considered the most effective form of universal precautions?
- A. Cap all used needles before removing them from their syringes
- B. Discard all used uncapped needles and syringes in an impenetrable protective container
- C. Wear gloves when administering IM injections
- D. Follow enteric precautions
Correct Answer: B
Rationale: The most effective form of universal precautions is to discard all used uncapped needles and syringes in an impenetrable protective container. This practice minimizes the risk of needle-stick injuries, which are a significant concern when dealing with used needles. By safely disposing of uncapped needles, healthcare providers can protect themselves and others from potential exposure to bloodborne pathogens.
During a Romberg test, the patient is asked to assume which position?
- A. Sitting
- B. Standing
- C. Genupectoral
- D. Trendelenburg
Correct Answer: B
Rationale: During a Romberg test, the patient is asked to stand with feet together and arms at the sides. The test evaluates proprioception and vestibular function by assessing the patient's ability to maintain balance with eyes closed. Asking the patient to stand helps to detect any balance issues or disturbances in the absence of visual input.
How can preserving skin integrity impact the circular chain of infection?
- A. Host
- B. Reservoir
- C. Mode of transmission
- D. Portal of entry
Correct Answer: D
Rationale: Preserving skin integrity plays a key role in breaking the chain of infection by eliminating the portal of entry for pathogens. When the skin is intact, it acts as a natural barrier that prevents pathogens from entering the body. By maintaining skin integrity through proper hygiene and wound care, the risk of infection is significantly reduced, disrupting the cycle of infection transmission.
To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures the hourly urine output. When should she notify the physician?
- A. Less than 30 ml/hour
- B. 64 ml in 2 hours
- C. 90 ml in 3 hours
- D. 125 ml in 4 hours
Correct Answer: A
Rationale: Notifying the physician is necessary when the urine output is less than 30 ml/hour as it indicates impaired kidney function. Adequate urine output is essential for monitoring kidney function, and a urine output less than 30 ml/hour could suggest potential renal issues that require medical attention.
The four main concepts common to nursing that appear in each of the current conceptual models are:
- A. Person, nursing, environment, medicine
- B. Person, health, nursing, support systems
- C. Person, health, psychology, nursing
- D. Person, environment, health, nursing
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.