Nokea
A faith community nurse is preparing to meet with the family of an adolescent who has leukemia. Which of the following actions should the nurse plan to take?
- A. Focus the discussion on the adolescent's future career plans.
- B. Determine how the adolescent's health has affected family roles.
- C. Ask another family from the same faith congregation to attend the meeting for support.
- D. Direct conversation to the parents to avoid embarrassing the adolescent.
Correct Answer: B
Rationale: The correct answer is B: Determine how the adolescent's health has affected family roles. This is important because the nurse needs to understand the impact of the adolescent's illness on the family dynamics and roles. By assessing this, the nurse can provide appropriate support and resources to help the family cope effectively.
Choice A is incorrect because focusing on the adolescent's future career plans may not address the immediate concerns and emotional needs of the family facing a health crisis.
Choice C is incorrect as involving another family may not be appropriate without the consent of the adolescent and their family.
Choice D is incorrect because directing the conversation solely to the parents may exclude the adolescent from being an active participant in their own care and may not address their unique needs.
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The partner of an older adult client who has Alzheimer's disease reports that he is not eating. The client's partner refuses to assist the client with feeding and insists the client feed himself without help. What is the priority action the nurse should take?
- A. Arrange for Meals on Wheels assistance
- B. Determine the client's ability to self-feed
- C. Direct the home health aide to assist with meals
- D. Refer the client's partner to an Alzheimer's support group
Correct Answer: B
Rationale: The correct answer is B: Determine the client's ability to self-feed. This is the priority action because it addresses the immediate concern of the client not eating due to the partner's refusal to assist. By assessing the client's ability to self-feed, the nurse can identify any barriers or challenges the client may be facing, such as physical limitations or cognitive impairments. This assessment will guide the nurse in developing an appropriate plan of care to ensure the client's nutritional needs are met.
The other choices are incorrect because they do not directly address the client's current situation.
A: Meals on Wheels assistance may be helpful but does not address the immediate need for the client to eat.
C: Directing the home health aide to assist assumes the client is willing to accept help, which may not be the case.
D: Referring the client's partner to an Alzheimer's support group is important for long-term support but does not address the immediate issue of the client not eating.
A community health nurse observes the accumulation of garbage at a neighborhood playground. Which of the following actions should the nurse take first to promote a clean and safe environment?
- A. Meet with community members to discuss methods of playground maintenance
- B. Partner city officials with community members to improve the playground condition
- C. Work with local businesses to sponsor more trash receptacles in the playground
- D. Engage neighborhood families to monitor the playground for further trash buildup
Correct Answer: A
Rationale: The correct answer is A: Meet with community members to discuss methods of playground maintenance. This is the first action the nurse should take because it involves engaging the community in addressing the issue collectively. By involving community members in the discussion, the nurse can gather insights, ideas, and support to develop effective strategies for maintaining the playground. This approach fosters community ownership and empowers residents to take responsibility for the cleanliness and safety of the playground.
Other choices are incorrect because:
B: Partnering with city officials may be necessary, but involving the community directly should be the initial step.
C: Working with local businesses to sponsor more trash receptacles may help, but community involvement is crucial for sustainable change.
D: Engaging neighborhood families to monitor the playground is important, but community collaboration is needed to address the root cause of the issue.
A home health nurse is scheduled for a first-time visit to a client. Which of the following should the nurse perform first?
- A. Blood pressure screening
- B. Mental status examination
- C. Review of the neighborhood
- D. Family history
Correct Answer: C
Rationale: The correct answer is C: Review of the neighborhood. This should be performed first to assess the safety and environment of the client's home, ensuring the nurse's safety and the ability to provide care effectively. It helps identify potential hazards or resources in the community. Blood pressure screening (A) can wait until after ensuring a safe environment. Mental status examination (B) is important but can be conducted after assessing the neighborhood. Family history (D) is not a priority for the first visit.
A client states, 'My life has no meaning right now.' What is the nurse's best response?
- A. Have you been thinking about harming yourself?
- B. How long have you been feeling this way?
- C. Tell me what is going on with you right now.
- D. Do you really think your life has no purpose?
Correct Answer: A
Rationale: The correct answer is A. By asking the client if they have been thinking about harming themselves, the nurse is directly addressing the potential risk of suicide, which is crucial when a client expresses feelings of hopelessness. This question helps assess the client's safety and determine the need for immediate intervention. Choices B, C, and D are not as direct in addressing the potential risk of self-harm and may not provide the necessary urgency in ensuring the client's safety. Asking about self-harm is critical in assessing the severity of the client's distress and ensuring appropriate interventions are implemented promptly.
A nurse is counseling a client who has a new diagnosis of chlamydia. Which of the following information should the nurse include in the teaching? (Select all that apply)
- A. You should avoid sexual contact until therapy is complete
- B. Notify anyone with whom you have had sexual contact over the past 2 months
- C. You will need to take an antiviral medication for 30 days
- D. Once you complete treatment, you will have an acquired immunity against chlamydia
- E. You might experience painful urination until the infection has resolved
Correct Answer: A, B, E
Rationale: The correct answers are A, B, and E. A is correct because avoiding sexual contact until therapy is complete helps prevent spreading chlamydia to others. B is correct as notifying sexual contacts allows for their treatment to prevent reinfection. E is correct because painful urination is a common symptom of chlamydia and should be expected until treatment resolves the infection. Choice C is incorrect because chlamydia is a bacterial infection, not a viral one, so antibiotics are used, not antivirals. Choice D is incorrect because completing treatment does not confer immunity against chlamydia; reinfection is possible.