Nokea
A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that:
- A. St. John's wort seldom relieves depression.
- B. She should avoid eating aged cheese.
- C. Skin reactions increase with the use of sunscreen.
- D. The herbal is safe to use with other antidepressants.
Correct Answer: C
Rationale: St. John's wort can cause photosensitivity, increasing the risk of skin reactions, so sunscreen use is recommended, not avoided.
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Each staff person has an individual password that allows access to electronic health records. Under which of the following circumstances should a nurse allow another staff person to use his/her password?
- A. A physician asks to use the password to access records of a former client.
- B. Another nurse asks to use the password because he has forgotten his own.
- C. The nurse's supervisor asks to use the password to access client records.
- D. The nurse should not allow anyone else to use the password, regardless of circumstances.
Correct Answer: D
Rationale: Passwords must not be shared (D) to protect patient confidentiality and comply with HIPAA. Sharing with a physician (A), nurse (B), or supervisor (C) is unauthorized.
The nurse is working in the ED when a client in labor comes in and says that she does not have health insurance, but wants to know if a doctor will see her. The nurse understands that the client's right to emergency services, regardless of ability to pay, is provided by which piece of legislation?
- A. HIPAA
- B. the Continuity of Care Act
- C. the Patient's Bill of Rights
- D. the Code of Ethics for Nurses
Correct Answer: D
Rationale: The Emergency Medical Treatment and Active Labor Act (EMTALA) ensures that emergency services are provided regardless of ability to pay, not the options listed.
The nurse is teaching a client with a new diagnosis of atrial fibrillation about warfarin (Coumadin) therapy. Which of the following statements by the client indicates a need for further teaching?
- A. I will avoid eating large amounts of spinach.
- B. I will report any signs of bleeding to my doctor.
- C. I will take my medication at the same time each day.
- D. I will stop taking the medication if I feel dizzy.
Correct Answer: D
Rationale: warfarin should not be stopped without medical advice, as it increases the risk of clotting
A nurse has delegated care of a client in wrist restraints to a nursing assistant. The nursing assistant should check the skin circulation under the restraints at least
- A. every 15 minutes.
- B. every 30 minutes.
- C. every hour.
- D. every 2 hours.
Correct Answer: C
Rationale: Restraints require circulation checks every 1-2 hours to prevent skin breakdown or neurovascular injury. Hourly checks (C) balance safety and practicality.
A 72-year-old client with Parkinson disease is recovering from pneumonia and is to be discharged, but he remains weak and has poor control of his hands because of tremors. A home health aide will visit three times weekly to assist the client to bathe, and his daughter will visit every evening after work to help with laundry and housework. Which of the following referrals is most indicated to allow the client to remain independent in his home?
- A. Home meal delivery program (Meals on Wheels)
- B. Friendly Visitors program
- C. Hospice
- D. Occupational therapist
Correct Answer: D
Rationale: An occupational therapist (D) can help with adaptive strategies for tremors, promoting independence. Meal delivery (A), visitors (B), and hospice (C) are less relevant.