Nurse evaluating how well client learned the info presented...

Nurse evaluating how well client learned the info presented in teaching about heart-healthy diet. Client states she understands what to do now. Which actions by nurse should assist evaluation of client's learning?

A. Encourage client to ask questions
B. Ask client to explain how to select or prepare meals
C. Encourage client to fill out eval form
D. Ask client if she has resources for further instruction on topic

Correct Answer: B

Rationale: The correct answer is B: Ask client to explain how to select or prepare meals. This action allows the nurse to assess the client's understanding by evaluating if the client can articulate the key concepts of a heart-healthy diet, demonstrating comprehension. It goes beyond a simple affirmation of understanding and requires the client to apply the knowledge. Encouraging questions (choice A) is important but may not provide a direct assessment of the client's grasp of the material. Choices C and D do not directly assess the client's understanding of the heart-healthy diet teachings.

Nurse reviewing CDC's immunization recommendations with parents of 2 preschoolers. Which recommendations should nurse include in this discussion? (Select all that apply.)

A. Haemophilus influenzae type b
B. Varicella
C. Polio
D. Hepatitis A
E. Seasonal influenza

Correct Answer: B,C,E

Rationale: The correct answers are B (Varicella), C (Polio), and E (Seasonal influenza). Varicella and seasonal influenza vaccines are recommended for preschoolers by the CDC to prevent the spread of these contagious diseases. Polio vaccine is important for preventing polio, a potentially serious disease that can be prevented through vaccination. Haemophilus influenzae type b, Hepatitis A, and the other choices are not typically part of the CDC's routine immunization recommendations for preschoolers. It is crucial for the nurse to include discussions on Varicella, Polio, and Seasonal influenza vaccines to ensure the children are protected from these preventable diseases.

Nurse is caring for a client with SARS. The nurse is aware that healthcare professionals are required to report communicable & infectious diseases. Which of these illustrate the rationale for reporting? (Select all that apply.)

A. Planning & evaluating control & prevention strategies
B. Determining public health priorities
C. Ensuring proper medical treatment
D. Identifying endemic disease
E. Monitoring for common-source outbreaks

Correct Answer: A,B,C,E

Rationale: The correct answers are A, B, C, and E. Reporting communicable diseases helps in planning and evaluating control strategies by identifying trends and risk factors. It also aids in determining public health priorities by allocating resources effectively. Reporting ensures proper medical treatment for infected individuals and helps in monitoring for common-source outbreaks to prevent further spread. Incorrect choices: D - Reporting does not specifically identify endemic diseases; F & G - Choices are not provided.

Nursing instructor is reviewing which actions nurses can initiate w/o provider's prescription. Students should identify which of following as nurse-initiated? (Select all that apply.)

A. Give morphine sulfate 1-2 mg IV every 1h as needed for pain
B. Insert NG tube to relieve client's gastric distension
C. Show client how to use progressive muscle relaxation
D. Perform daily bath after evening meal
E. Re-position client every 2h to reduce pressure ulcer risk

Correct Answer: C, D, E

Rationale: Correct Answer: C, D, E

Rationale:
C: Showing a client how to use progressive muscle relaxation is an example of a nurse-initiated action as it involves client education and does not require a provider's prescription.
D: Performing a daily bath after the evening meal is a routine nursing care activity that can be initiated by the nurse without a provider's prescription.
E: Re-positioning a client every 2 hours to reduce the risk of pressure ulcers is an essential nursing intervention that can be initiated by the nurse without a provider's prescription.

Summary of Incorrect Choices:
A: Giving morphine sulfate IV every 1 hour as needed for pain requires a provider's prescription due to the administration of a controlled substance.
B: Inserting an NG tube to relieve gastric distension is an invasive procedure that typically requires a provider's order and specialized training.

Nurse transferring a client from an acute-care hospital to a rehab facility. Which of the following info about the client should the nurse include in the transfer report? (Select all that apply.)

A. Alert & oriented
B. Refuses to eat spinach
C. Has shellfish allergy
D. Requests morphine every 4h
E. Misses the 2 cats he has at home

Correct Answer: A,C,D

Rationale: The correct answers are A, C, and D.

A: Including that the client is alert and oriented is crucial for providing a comprehensive overview of the client's mental status and ability to participate in the rehabilitation program.

C: Informing about the shellfish allergy is essential for ensuring the client's safety and preventing any potential allergic reactions during their stay at the rehab facility.

D: Noting the client's request for morphine every 4 hours is important for ensuring that their pain management needs are properly addressed during their transition to the rehab facility.

B, E: Refusing to eat spinach and missing cats at home are not relevant pieces of information that directly impact the client's care during their transfer to the rehab facility.

Nurse counseling young adult who describes having difficulty dealing with several issues. Which problem should nurse identify as priority for further assessment & intervention?

A. "I have my own apt now
B. but it's not easy living away from my parents."
C. It's been so stressful for me to even think about having my own family.
D. I don't even know who I am yet, & now I'm supposed to know what to do.
E. My girlfriend is pregnant, & I don't think I have what it takes to be a good father.

Correct Answer: C

Rationale: The correct answer is C: "It's been so stressful for me to even think about having my own family." This is the priority issue as it indicates the young adult is struggling with the idea of starting a family, which can have long-term implications. This concern may affect their mental health, relationships, and decision-making. Option A is about independence, B about transitioning from parents, D about self-identity, and E about impending fatherhood. While important, these issues are not as urgent as the stress related to starting a family.