Nokea
A client with a peptic ulcer is scheduled for a vagotomy and pyloroplasty. The nurse explains that the purpose of this surgery is to:
- A. Increase acid secretion
- B. Reduce acid secretion
- C. Promote gastric emptying
- D. Remove the ulcerated area
Correct Answer: B
Rationale: The correct answer is B: "Reduce acid secretion." Vagotomy is performed to reduce acid secretion by cutting the vagus nerve, which stimulates acid production. Choices A, C, and D are incorrect. A vagotomy does not increase acid secretion, promote gastric emptying, or remove the ulcerated area. It specifically aims to decrease acid production to help in the healing of peptic ulcers.
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A school nurse is assessing a child who has frequent absences from school due to asthma. Which of the following is the priority nursing action?
- A. Teaching the child how to use an inhaler
- B. Assessing the child's asthma management plan
- C. Discussing the importance of school attendance with the parents
- D. Referring the child to a pulmonologist
Correct Answer: B
Rationale: The correct answer is to assess the child's asthma management plan. This is the priority action as it allows the nurse to evaluate the current treatment regimen, identify any gaps or areas for improvement, and ensure that the plan is being effectively implemented. Teaching the child how to use an inhaler (Choice A) may be important but should come after assessing the management plan. Discussing the importance of school attendance with the parents (Choice C) is secondary to ensuring proper asthma management. Referring the child to a pulmonologist (Choice D) may be necessary but is not the priority at this stage; first, the nurse needs to evaluate the current plan in place.
A nurse manager is using the technique of brainstorming to help solve a problem. One nurse criticizes another nurse's contribution and begins to find objections to the suggestion. The nurse manager's best response is to
- A. Let's move on to a new action that deals with the problem.
- B. I think you need to reserve judgment until after all suggestions are offered.
- C. Very well thought out. Your analytic skills and interest are incredible.
- D. Let's move to the 'what if…' as related to these objections for an exploration of spin-off ideas.
Correct Answer: D
Rationale: Encouraging the group to explore 'what if' scenarios based on the objections helps to maintain a positive and creative brainstorming atmosphere, while also validating the concerns raised by the nurse. Choice A is dismissive and does not address the issue at hand. Choice B suggests postponing judgment, which may not resolve the tension caused by the criticism. Choice C is complimentary but does not address the critical feedback provided by the nurse, missing an opportunity to turn objections into opportunities for further exploration.
When a nurse teaches a community about the importance of regular health screenings, this activity falls under which level of prevention?
- A. Primary prevention
- B. Secondary prevention
- C. Tertiary prevention
- D. Quaternary prevention
Correct Answer: B
Rationale: The correct answer is B: Secondary prevention. Secondary prevention aims to detect and treat disease early to prevent complications. Teaching about the importance of regular health screenings helps in early detection and intervention, which aligns with the goals of secondary prevention.
Choice A, Primary prevention, involves actions to prevent the onset of a health condition. Choice C, Tertiary prevention, focuses on managing and treating existing conditions to prevent further complications. Choice D, Quaternary prevention, relates to actions taken to mitigate or avoid unnecessary interventions, over-medicalization, and the consequences of unnecessary treatment.
Occupational health nursing is concerned with the following except:
- A. educating workers about health
- B. immediate diagnosis of illness prevailing in the work field
- C. appropriate and effective ways of promoting health
- D. planning of administering health services
Correct Answer: B
Rationale: Occupational health nursing focuses on educating workers about health, promoting health through appropriate and effective ways, and planning and administering health services in the workplace. Immediate diagnosis of illness prevailing in the work field is typically not the primary role of occupational health nursing, as it usually involves prevention, education, and health promotion rather than diagnosing acute conditions.
While performing an initial assessment on a newborn following a breech delivery, the nurse suspects hip dislocation. Which of the following is most suggestive of the abnormality?
- A. Flexion of lower extremities
- B. Negative Ortolani response
- C. Lengthened leg of affected side
- D. Irregular hip symmetry
Correct Answer: D
Rationale: Irregular hip symmetry, such as asymmetry in the gluteal folds, is a common sign of hip dislocation in newborns. This finding indicates a potential abnormality in hip development and requires further evaluation and possible treatment. Choices A, B, and C are incorrect. Flexion of lower extremities is a normal newborn reflex, the Ortolani response is used to detect hip dysplasia rather than hip dislocation, and a lengthened leg of the affected side is not typically associated with hip dislocation in newborns.