Nokea
A 56-year-old female client is receiving intracavitary radiation via a radium implant. Which nurse should be assigned to care for this client?
- A. A nurse who is pregnant.
- B. A nurse with Marfan syndrome who is postmenopausal.
- C. A nurse with a cold.
- D. A nurse who is lactating.
Correct Answer: B
Rationale: A nurse with Marfan syndrome who is postmenopausal can safely care for the client because Marfan syndrome does not affect the ability to care for this client, and postmenopausal status minimizes the risk of radiation exposure affecting reproductive health. Choice A is incorrect because pregnancy increases the risk of radiation exposure to the fetus. Choice C is incorrect because a nurse with a cold may have a compromised immune system and should not be exposed to radiation therapy. Choice D is incorrect because lactation can increase the risk of radiation exposure to breast tissue.
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A homeless client with alcohol dependency will be dismissed from the emergency department in 24 hours. The nurse notes that a tuberculin skin test was prescribed by the healthcare provider. What intervention is most important for the nurse to implement prior to discharge?
- A. Identify how the client will follow-up to have the results read
- B. Give the client written information about the tuberculosis test
- C. Determine if the client understands the purpose of the tuberculin test
- D. Explain to the client results should be read between 48 and 72 hours
Correct Answer: A
Rationale: The most important intervention for the nurse to implement prior to the discharge of a homeless client with alcohol dependency who had a tuberculin skin test prescribed is to identify how the client will follow-up to have the results read. This is crucial to ensure proper diagnosis and treatment. Providing written information (Choice B) is helpful but not as critical as ensuring the follow-up plan. Determining if the client understands the purpose of the test (Choice C) is important but not as immediate as ensuring the follow-up plan. Explaining when the results should be read (Choice D) is important, but the priority is to make sure the client has a plan in place for follow-up.
The school nurse is preparing a presentation on the importance of physical activity for elementary school students. Which benefit should the nurse emphasize?
- A. Improved academic performance
- B. Increased social interactions
- C. Enhanced physical strength
- D. Better sleep patterns
Correct Answer: A
Rationale: The correct answer is A: Improved academic performance. Physical activity has been shown to improve academic performance by enhancing concentration and cognitive function. This benefit is particularly important for elementary school students who are developing foundational skills. Choice B, increased social interactions, while important for overall development, may not directly relate to the academic aspect that the nurse is focusing on. Choice C, enhanced physical strength, is a valid benefit of physical activity but may not be as relevant to academic performance as the ability to concentrate and learn. Choice D, better sleep patterns, is also a valuable outcome of physical activity but is not as directly linked to academic performance as improved cognitive function.
During a community health fair, the nurse conducts a blood pressure screening for a 60-year-old woman who has a blood pressure of 160/100 mm Hg. What should the nurse do first?
- A. Instruct the client to monitor her blood pressure at home
- B. Refer the client to her healthcare provider for further evaluation
- C. Educate the client on lifestyle changes to reduce blood pressure
- D. Recheck the blood pressure in 15 minutes
Correct Answer: B
Rationale: When encountering a high blood pressure reading at a community health fair, it is essential for the nurse to refer the client to her healthcare provider for further evaluation. This step ensures that the client receives a comprehensive assessment, diagnosis, and appropriate management plan. In this scenario, it is crucial to prioritize professional evaluation over self-monitoring, lifestyle education, or immediate rechecking of the blood pressure. Referral to a healthcare provider allows for timely intervention and ongoing monitoring of the client's blood pressure to prevent potential complications.
A client with a head injury is admitted to the hospital. Which finding indicates a need for immediate intervention?
- A. Glasgow Coma Scale (GCS) score of 15.
- B. Pupils are equal and reactive to light.
- C. Client is drowsy but arousable.
- D. Client does not remember the events leading to the injury.
Correct Answer: C
Rationale: In a client with a head injury, being drowsy but still arousable can be a sign of increased intracranial pressure, which necessitates immediate intervention. This presentation may indicate a deterioration in neurological status, requiring prompt assessment and management to prevent further complications. Choices A, B, and D are not indicative of an immediate need for intervention in this scenario. A Glasgow Coma Scale (GCS) score of 15 indicates the highest level of consciousness; pupils being equal and reactive to light suggest intact cranial nerve function, and memory loss about the injury event is common in head injuries and does not necessarily warrant immediate intervention.
An older client requiring total care resides with a family consisting of two daughters who take shifts providing care around-the-clock. During a home visit, the daughters ask the nurse about resources that are available for client care while they attend a scheduled family reunion. Which information is best for the nurse to provide?
- A. propose the family seek assistance for care in the area of the reunion's location
- B. tell the caregivers to consider hiring a private duty nurse during the time away
- C. advise to have a case management evaluation of the client's home environment
- D. suggest social services be contacted to find a respite care facility for the client
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.