Nokea
A client is receiving hospice and palliative care, including analgesia and other comfort measures. Which of the following indicates the client is undergoing life review? Select all that apply.
- A. The client looks through old photo albums.
- B. The client states that her analgesia is not adequate.
- C. The client reminisces about her children when they were young and her parenting skills.
- D. The client states that she is ready to die.
- E. The client states she does not want her children to have a funeral for her.
Correct Answer: A,C
Rationale: Looking at photos (A) and reminiscing about parenting (C) indicate life review, reflecting on past experiences. Other statements (B, D, E) relate to pain or end-of-life wishes.
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Which clients can be assigned to share a room in the emergency department during the disaster?
- A. A client having auditory hallucinations and the client with ulcerative colitis
- B. The client who is pregnant and the client with a broken arm
- C. A child who is cyanotic with severe dypsnea and a client with a frontal head injury
- D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain
Correct Answer: B
Rationale: The pregnant client and the client with a broken arm have stable conditions, making them suitable to share a room.
The nurse is caring for an infant receiving intravenous fluid. Signs of fluid overload in an infant include:
- A. Swelling of the hands and increased temperature
- B. Increased heart rate and increased blood pressure
- C. Swelling of the feet and increased temperature
- D. Decreased heart rate and decreased blood pressure
Correct Answer: B
Rationale: Fluid overload in infants can cause increased heart rate and blood pressure due to increased intravascular volume.
According to Erikson's stages of physical development, school-age children 5 - 12 years old typically face which psychological crisis?
- A. ego integrity versus despair
- B. industry versus inferiority
- C. trust versus mistrust
- D. ego identity versus role confusion
Correct Answer: B
Rationale: School-age children (5-12) face industry vs. inferiority, focusing on developing competence and self-esteem through tasks and skills.
The registered nurse is conducting an in-service for colleagues on the subject of peptic ulcers. The nurse would be correct in identifying which of the following as a causative factor?
- A. N. gonorrhea
- B. H. influenza
- C. H. pylori
- D. E. coli
Correct Answer: C
Rationale: H. pylori is a primary causative factor in peptic ulcers, contributing to mucosal damage and ulcer formation.
An RN is working with an LPN to care for a group of clients. Which client would the RN most likely assign to the LPN?
- A. a client receiving blood following back surgery
- B. a client who has just returned from having a left heart catheterization
- C. a client with an arterial line who is on a nitroprusside drip to control blood pressure
- D. a client with an abdominal wound requiring dressing changes every 4 hours and PRN
Correct Answer: D
Rationale: The client requiring dressing changes is stable and within the LPN's scope of practice, whereas the other clients require advanced monitoring or interventions suitable for an RN.