Nokea
A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurses best response?
- A. Theres no way to be sure you wont get HIV except to use condoms correctly.
- B. Only the correct use of a female condom protects against the transmission of HIV.
- C. There are new ways of protecting yourself from HIV that are being discovered every day.
- D. Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV.
Correct Answer: D
Rationale: The correct answer is D because it emphasizes the importance of consistent and correct condom use in preventing HIV transmission. Here's the rationale:
1. Abstinence is the most effective way to prevent HIV, but since the teen is sexually active, abstinence may not be feasible for her.
2. Using condoms consistently and correctly is the next best method for preventing HIV transmission during sexual activity.
3. Choice A is incorrect because it implies that using condoms is not effective, which is not true.
4. Choice B is incorrect because it only mentions female condoms, while both male and female condoms can be effective in preventing HIV.
5. Choice C is incorrect because while new prevention methods are being researched, the established method of consistent condom use remains the most effective.
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In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?
- A. Supplement breast milk with corn syrup.
- B. Give cow’s milk during the first year of life.
- C. Add honey to infant formulas for increased energy.
- D. Provide breast milk or formula for the first 4 to 6 months.
Correct Answer: D
Rationale: The correct answer is D because breast milk or formula is recommended for the first 4 to 6 months as it provides essential nutrients for infant growth and development. Choosing A, B, or C is incorrect as they pose health risks to infants - corn syrup is not necessary, cow's milk is not suitable for infants, and honey can cause botulism in infants under 1 year old. Breast milk or formula is the safest and most nutritionally balanced option for infants in the first few months of life.
A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time?
- A. Advise the patient that this is an overgrowth of normal vaginal flora.
- B. Discuss the effect of this diagnosis on the patients fertility.
- C. Document the vaginal discharge as normal.
- D. Administer acyclovir as ordered.
Correct Answer: A
Rationale: The correct answer is A: Advise the patient that this is an overgrowth of normal vaginal flora. This is correct because Gardnerella vaginalis is a bacteria associated with bacterial vaginosis, which is an overgrowth of normal vaginal flora. By advising the patient of this, the nurse practitioner can provide education on the condition and treatment options.
B: Discussing the effect of this diagnosis on the patient's fertility is incorrect as Gardnerella vaginalis is not typically associated with fertility issues.
C: Documenting the vaginal discharge as normal is incorrect as Gardnerella vaginalis is indicative of an abnormal vaginal flora imbalance.
D: Administering acyclovir as ordered is incorrect as acyclovir is an antiviral medication used to treat herpes simplex virus infections, not bacterial vaginosis caused by Gardnerella vaginalis.
A patient has been diagnosed with glaucoma and the nurse is preparing health education regarding the patients medication regimen. The patient states that she is eager to beat this disease and looks forward to the time that she will no longer require medication. How should the nurse best respond?
- A. You have a great attitude. This will likely shorten the amount of time that you need medications.
- B. In fact, glaucoma usually requires lifelong treatment with medications.
- C. Most people are treated until their intraocular pressure goes below 50 mm Hg.
- D. You can likely expect a minimum of 6 months of treatment.
Correct Answer: B
Rationale: The correct answer is B: In fact, glaucoma usually requires lifelong treatment with medications.
1. Glaucoma is a chronic condition characterized by increased intraocular pressure.
2. Lifelong treatment is usually necessary to manage intraocular pressure and prevent vision loss.
3. Stopping medication prematurely can lead to worsening of the condition.
4. Therefore, the nurse should educate the patient about the need for ongoing medication to manage glaucoma effectively.
Summary:
A: Incorrect. Having a positive attitude is beneficial, but it does not shorten the duration of glaucoma treatment.
C: Incorrect. The target intraocular pressure is usually below 21 mm Hg, not 50 mm Hg.
D: Incorrect. Glaucoma treatment is typically long-term, not limited to 6 months.
A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond?
- A. Not until the drain is removed
- B. On the second postoperative day
- C. Now, if you wash gently with soap and water
- D. Seven days after your surgery
Correct Answer: A
Rationale: The correct answer is A: Not until the drain is removed. After a mastectomy with immediate reconstruction, there is typically a drain in place to collect fluid. Showering before the drain is removed can increase the risk of infection and disrupt the healing process. It is important to wait until the healthcare provider removes the drain to ensure proper healing and reduce the risk of complications.
Summary:
B: On the second postoperative day - Too early, the drain needs to be removed first.
C: Now, if you wash gently with soap and water - Incorrect, the drain should be removed before showering.
D: Seven days after your surgery - Incorrect, waiting for a specific number of days is not necessary, it depends on when the drain is removed.
A patient has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray?
- A. Explain the location of items using clock cues.
- B. Explain that each of the items on the tray is clearly separated.
- C. Describe the location of items from the bottom of the plate to the top.
- D. Ask the patient to describe the location of items before confirming their location.
Correct Answer: A
Rationale: The correct answer is A because using clock cues helps the patient visualize the placement of items based on a familiar concept. This aids in compensating for the loss of vision after head trauma. Choice B does not provide specific guidance on how to describe the placement. Choice C may be confusing for the patient as it is not a common way to describe item placement. Choice D puts unnecessary burden on the patient to describe the location first before confirming, which may be challenging for someone with sudden loss of vision.