Nokea
A client was admitted to the community palliative care unit ten years after being diagnosed with multiple sclerosis (MS). Which intervention should the nurse prioritize in the client's care plan?
- A. Allow the family to visit whenever they wish.
- B. Administer medication as needed for pain and anxiety.
- C. Maintain a quiet environment with low lighting.
- D. Allow the client to participate in the care provided.
Correct Answer: B
Rationale: Administering medication as needed for pain and anxiety should be prioritized in the care plan for a client with MS in a palliative care unit. MS can cause varying degrees of pain and anxiety, and managing these symptoms can significantly improve the client's quality of life during the advanced stages of the disease.
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After assessing the health care needs of an elementary school, the nurse determines that an increased prevalence of pediculosis capitis is a priority problem. The nurse develops a 2-month program with the goal to eradicate the condition in the school. The program includes educational pamphlets sent home to parents and regular assessment of children by the school nurse. What action should the nurse implement to evaluate the effectiveness of the program?
- A. Survey parents 3 weeks after pamphlets are sent home to assess their understanding of the condition.
- B. Evaluate the teacher's ability to identify pediculosis capitis 2 months after initiation of the program.
- C. Measure the prevalence of pediculosis capitis among the children after four months.
- D. Conduct an initial examination of each child in the school to obtain baseline data.
Correct Answer: C
Rationale: Measuring the prevalence of pediculosis capitis among the children after four months would directly assess the effectiveness of the program. A decrease in the prevalence of the condition would indicate that the program was effective.
After the first injection of the Hepatitis B Vaccine (HBV) series is administered to a group of healthcare workers, what advice should the nurse give to them?
- A. Suggest that they stay with someone for 10 hours post-injection.
- B. Advise them to bring a family member along for the final injection.
- C. Urge them to get all their family members vaccinated as soon as possible.
- D. Recommend annual blood tests to monitor their immunization levels.
Correct Answer: D
Rationale: Regular monitoring of immunization levels is important after receiving the HBV series. This is because healthcare workers are at a higher risk of exposure to Hepatitis B, and ensuring immunity is crucial for their safety.
A community health nurse who works in a Gulf Coast town that caters to tourists is conducting a disaster management class for residents and business owners. What is the most important content for the nurse to include in this class?
- A. Methods used to treat water to ensure it is safe to drink.
- B. Available evacuation routes from the town.
- C. Hurricane preparedness for families and businesses.
- D. Actions to be taken during a tornado.
Correct Answer: C
Rationale: Given the geographical location of the Gulf Coast town, hurricane preparedness for families and businesses is the most important content to include in the class. Hurricanes are a common natural disaster in this area, and being prepared can help reduce the impact of such events.
The nurse is caring for a patient with the sexually transmitted infection (STI) gonorrhea. The patient reports having multiple sexual partners. What response should the nurse provide?
- A. Emphasize that practicing safe sex eliminates the risk of STIs.
- B. Instruct the patient on the importance of informing sexual partners.
- C. Discuss that partners without similar symptoms may not be infected.
- D. Clarify that all STIs are transmitted through sexual intercourse.
Correct Answer: B
Rationale: Informing sexual partners about a gonorrhea diagnosis is crucial. Gonorrhea is a highly contagious infection that can be transmitted through sexual contact. If a person has been diagnosed with gonorrhea, their sexual partners may also be at risk and should be informed so they can seek testing and treatment if necessary.
The nurse is screening for hypertension at a local health fair. A community resident has a blood pressure reading of 138/80 mm Hg. What interventions should the nurse implement for this client? Select all that apply.
- A. Encourage the client to “keep doing whatever you are doing.â€.
- B. Assess the client's lifestyle and other risk factors for hypertension.
- C. Ask the client about any current antihypertensive medications.
- D. Obtain another blood pressure reading to verify the first reading.
- E. Recommend further evaluation for possible pre-hypertension.
Correct Answer: B,C,D,E
Rationale: Assessing the client's lifestyle and other risk factors for hypertension, asking about current antihypertensive medications, obtaining another blood pressure reading to verify the first reading, and recommending further evaluation for possible pre-hypertension are all appropriate interventions for a client with a blood pressure reading of 138/80 mm Hg, which indicates possible pre-hypertension.