Nokea
A nurse is caring for a patient who is post-operative following a knee replacement. Which of the following should the nurse prioritize in the post-operative care plan?
- A. Pain management.
- B. Encouraging early ambulation.
- C. Administering IV antibiotics.
- D. Monitoring for signs of deep vein thrombosis.
Correct Answer: B
Rationale: The correct answer is B: Encouraging early ambulation. Early ambulation helps prevent complications such as blood clots, improves circulation, aids in lung expansion, and promotes faster recovery. Pain management is important but encouraging mobility is a priority. Administering IV antibiotics is not necessary unless there is an infection present. Monitoring for signs of deep vein thrombosis is important but encouraging ambulation is a proactive approach to prevent its occurrence.
You may also like to solve these questions
A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The nurse should monitor for which of the following signs of an exacerbation?
- A. Increased sputum production.
- B. Decreased respiratory rate.
- C. Low blood pressure.
- D. High fever.
Correct Answer: A
Rationale: 1. Increased sputum production is a sign of COPD exacerbation due to worsening inflammation and mucus production.
2. Decreased respiratory rate is not typical in COPD exacerbation as patients often experience increased respiratory effort.
3. Low blood pressure is not a common sign of COPD exacerbation and is more likely related to other conditions or medications.
4. High fever is not a typical sign of COPD exacerbation and could indicate an infection or other underlying issue.
While working in the surgical unit, the nurse notices that a patient speaks a language that she cannot understanThe nurse is aware that the hospital has a number of postoperative instructions, translated videos, and brochures in this patient's language, in addition to having a translator on staff. These are all examples of:
- A. language services that are available to all admitted patients.
- B. the standards for cultural and linguistically appropriate services.
- C. ways of addressing diverse communication needs.
- D. efforts to improve patient satisfaction and care
Correct Answer: B
Rationale: The correct answer is B: the standards for cultural and linguistically appropriate services. The rationale is as follows:
1. Cultural and linguistically appropriate services ensure that patients receive care that is respectful of and responsive to their cultural and linguistic needs.
2. Having translated materials and a translator on staff aligns with these standards by providing access to healthcare information in the patient's language.
3. By offering postoperative instructions and resources in the patient's language, the hospital is promoting effective communication and understanding.
4. These services aim to reduce language barriers, improve patient outcomes, and enhance the overall quality of care.
Which of the following is an example of a secondary prevention activity?
- A. Routine immunizations
- B. Health screenings such as mammograms
- C. Smoking cessation programs
- D. Health education on healthy eating
Correct Answer: B
Rationale: The correct answer is B, Health screenings such as mammograms, because secondary prevention focuses on early detection and treatment of diseases to prevent progression. Health screenings help identify conditions at early stages, allowing for timely intervention. Routine immunizations (A) are considered primary prevention as they prevent diseases from occurring. Smoking cessation programs (C) and health education on healthy eating (D) are examples of primary prevention, as they aim to prevent the development of diseases by promoting healthy behaviors.
A nurse is teaching a patient with a history of hypertension about lifestyle modifications. Which of the following statements by the patient indicates the need for further education?
- A. I will monitor my blood pressure regularly.
- B. I will take my medication as prescribed.
- C. I can stop taking my medication once my blood pressure is normal.
- D. I will reduce my sodium intake.
Correct Answer: C
Rationale: The correct answer is C because it indicates a misunderstanding about hypertension management. Patients should continue taking medication even if blood pressure is normal to prevent future complications. Monitoring blood pressure regularly (A) is important for tracking progress. Taking medication as prescribed (B) is crucial for controlling blood pressure. Reducing sodium intake (D) helps lower blood pressure. Choice C is incorrect as stopping medication prematurely can lead to uncontrolled hypertension.
A nurse is assessing a patient's hydration status. Which of the following findings would suggest dehydration?
- A. Increased urine output
- B. Decreased heart rate
- C. Dry mucous membranes
- D. Increased blood pressure
Correct Answer: C
Rationale: The correct answer is C: Dry mucous membranes. Dry mucous membranes are a common sign of dehydration as the body lacks adequate fluid. When a person is dehydrated, there is a decrease in saliva production, leading to dryness in the mouth and throat. This can be easily observed during a physical examination by looking at the patient's lips, tongue, and inside of the mouth. On the other hand, increased urine output (choice A) is a sign of adequate hydration, decreased heart rate (choice B) can be a normal response to dehydration but is not a consistent indicator, and increased blood pressure (choice D) is not typically associated with dehydration. Therefore, dry mucous membranes are the most reliable finding to suggest dehydration in a patient.