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A client is being assessed by a nurse who is 30 minutes postoperative following an arterial thrombectomy. Which of the following findings should the nurse report?
- A. Chest pain
- B. Muscle spasms
- C. Cool, moist skin
- D. Incisional pain
Correct Answer: A
Rationale: Chest pain is a critical finding postoperatively, especially after an arterial thrombectomy, as it could indicate complications like myocardial infarction or pulmonary embolism. It requires immediate attention and further evaluation. Muscle spasms, cool moist skin, and incisional pain are important to assess but not as urgent as chest pain in this scenario.
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While teaching a newly hired nurse about varicella, a nurse in a pediatric clinic should include which of the following information?
- A. Children who have varicella are contagious until vesicles are crusted.
- B. Children who have varicella should receive the varicella (chickenpox) vaccine.
- C. Children who have varicella should be placed in airborne precautions.
- D. Children who have varicella are contagious 1-2 days before the rash appears.
Correct Answer: A
Rationale: Children with varicella (chickenpox) are contagious until all vesicles are crusted over. The contagious period starts 1-2 days before the rash appears and continues until all lesions are dried and crusted. It is important to educate healthcare providers about the contagious period to prevent the spread of the virus to susceptible individuals.
When caring for a client who speaks a language different from their own, what action should the nurse take?
- A. Request an interpreter of a different sex from the client.
- B. Request a family member or friend to interpret information for the client.
- C. Direct attention toward the interpreter when speaking to the client.
- D. Review the facility policy about the use of an interpreter.
Correct Answer: D
Rationale: When caring for a client who speaks a different language, it is essential for the nurse to review the facility policy about the use of an interpreter. Using a professional interpreter ensures accurate communication and protects the client's confidentiality. Requesting an interpreter of a specific sex or relying on family members or friends can lead to miscommunication or breaches of confidentiality. Directing attention towards the interpreter helps facilitate communication but does not address the need for a professional interpreter as per facility policy.
During physical therapy, a client with Parkinson's disease makes the following statements. Which statement indicates the need for a referral to physical therapy?
- A. ''I have been experiencing more tremors in my left arm than before''
- B. ''I noticed that I am having a harder time holding on to my toothbrush''
- C. ''Lately, I feel like my feet are freezing up, as they are stuck to the ground''
- D. ''Sometimes, I feel I am making a chewing motion when I'm not eating''
Correct Answer: C
Rationale: Feeling like the feet are freezing up and sticking to the ground is a common symptom of Parkinson's disease known as 'freezing of gait.' This symptom significantly impacts mobility and can be dangerous, indicating the need for specialized physical therapy interventions to address gait disturbances and improve mobility.
A healthcare professional is completing an incident report after a client fall. Which of the following competencies of Quality and Safety Education for Nurses is the professional demonstrating?
- A. Quality improvement
- B. Patient-centered care
- C. Evidence-based practice
- D. Informatics
Correct Answer: A
Rationale: Completing an incident report after a client fall aligns with the competency of quality improvement, which focuses on identifying system errors and implementing changes to improve patient outcomes and safety. Patient-centered care emphasizes involving patients in their care decisions, evidence-based practice involves integrating research and clinical expertise, and informatics involves using technology to improve patient care. In this scenario, the emphasis is on the process of improving quality and safety related to the incident.
A client with fibromyalgia requests pain medication. Which of the following medications should the nurse administer?
- A. Pregabalin
- B. Lorazepam
- C. Colchicine
- D. Codeine
Correct Answer: A
Rationale: Pregabalin is commonly used to manage pain associated with fibromyalgia. It works by reducing the number of pain signals sent out by damaged nerves. Lorazepam is a benzodiazepine used for anxiety, not pain management. Colchicine is primarily used for gout treatment, and codeine, while an analgesic, is not typically the first-line choice for fibromyalgia pain due to its potential for side effects and misuse.