Nokea
A nurse is assessing a client who is at 31 weeks of gestation. Which of the following findings show potential prenatal complication?
- A. Periodic tingling of fingers
- B. Absence of clonus
- C. Leg cramps
- D. Blurred vision
Correct Answer: D
Rationale: Blurred vision is a potential prenatal complication during the third trimester of pregnancy and can be a sign of conditions such as preeclampsia or gestational diabetes. It is important for the nurse to further assess this finding and consult with the healthcare provider to ensure appropriate management and monitoring of the client's condition. Periodic tingling of fingers, absence of clonus, and leg cramps are common discomforts during pregnancy and do not typically indicate a prenatal complication.
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What is an example of a nurse's question that is part of the Four Cs?
- A. What did you do to cause your injury?
- B. What are you concerned about today?
- C. What kind of problems will your traditions cause for other patients?
- D. When will your family move you in to stay with them?
Correct Answer: B
Rationale: The Four Cs (Concerns, Causes, Comfort, and Collaboration) focus on understanding the patient's perspective and concerns.
Which statement is the most accurate to make dents about the highest risk group for gonorrhea. to the parents of a newborn during discharge What is the age range of the clients?
- A. 36 to 45 years
- B. Meconium stools should be expected to resolve
- C. 14 to 25 years
- D. 26 to 35 years
Correct Answer: C
Rationale: The age group of 14 to 25 years is considered the highest risk group for gonorrhea, making it important to discuss this with parents during discharge. This age range includes adolescents and young adults who are more likely to engage in risky sexual behaviors and therefore have a higher chance of contracting sexually transmitted infections like gonorrhea. Educating parents about this risk group can help them be more aware and take steps to protect their child as they grow older.
Which comment shows understanding of care for an asymptomatic woman being treated for HIV infection?
- A. If I get pregnant, my baby will be HIV positive.
- B. I should have my viral load and antibody levels checked every day.
- C. Since my partner and I are both HIV positive, we use a condom.
- D. To be safe, my partner and I engage only in oral sex.
Correct Answer: C
Rationale: Condom use reduces the risk of HIV transmission even between seroconcordant partners.
The nurse is caring for a woman with a broken arm. Her partner brings in flowers and balloons and is overly affectionate. What phase of the cycle of violence would the nurse suspect?
- A. tension-building
- B. acute battering incident
- C. honeymoon phase
- D. loving phase
Correct Answer: C
Rationale: The honeymoon phase in the cycle of violence is characterized by remorse and attempts by the abuser to regain control through affection or gifts. This phase manipulates the victim into believing the abuse will not recur.
A nurse is conducting an orientation program for a group of newly hired nurses. As part of the program, the nurse is reviewing the issue of informed consent. The nurse determines that the teaching was effective when the group identifies which situation as a violation of informed consent?
- A. Performing a procedure on a 15-year-old without parental consent
- B. Serving as a witness to the signature process on an operative permit
- C. Asking whether the client understands what she is signing following receiving education
- D. Getting verbal consent over the phone for an emergency procedure from the spouse of a unconscious woman
Correct Answer: A
Rationale: In most states, only clients over the age of 18 can legally provide consent for health care. Serving as a witness to the signature process, asking whether the client understands what she is signing, and getting verbal consent over the phone for emergency procedures are all key to informed consent and are not violations.