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A nurse is gathering information about a patients habits and lifestyle patterns. Which method of data collection will the nurse use that will best obtain this information?
- A. Carefully review lab results.
- B. Conduct the physical assessment.
- C. Perform a thorough nursing health history.
- D. Prolong the termination phase of the interview.
Correct Answer: C
Rationale: The correct answer is C: Perform a thorough nursing health history. This method is the best for gathering information about a patient's habits and lifestyle patterns because it involves asking specific questions related to the patient's daily routines, habits, and lifestyle choices. By obtaining a comprehensive health history, the nurse can gather valuable information about the patient's diet, exercise habits, sleep patterns, stress levels, substance use, and other lifestyle factors that may impact their health. Reviewing lab results (A) may provide some information but not specifically about habits and lifestyle. Conducting a physical assessment (B) focuses more on the patient's physical condition rather than lifestyle. Prolonging the termination phase of the interview (D) is not a method of data collection and does not focus on gathering information about habits and lifestyle patterns.
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A male client who is HIV positive is admitted to the hospital with a diagnosis of Pneumocystis carinii pneumonia. His live-in partner has accompanied him. During the history interview, the nurse is aware of feeling a negative attitude about the client’s lifestyle, what action is most appropriate?
- A. Share these feelings with the client
- B. Discuss the negative feelings with the
- C. Develop a written interview form charge nurse
- D. Avoid eye contact with the client
Correct Answer: B
Rationale: The correct answer is B: Discuss the negative feelings with the client. This is the most appropriate action as it allows the nurse to address and manage their own biases and attitudes towards the client in a professional and constructive manner. By acknowledging and discussing these feelings with the client, the nurse can work towards providing non-judgmental care and fostering a therapeutic relationship.
A: Sharing these feelings with the client is not appropriate as it can harm the nurse-client relationship and potentially lead to discrimination.
C: Developing a written interview form is not addressing the immediate issue of the nurse's negative attitude towards the client.
D: Avoiding eye contact with the client is unprofessional and does not address the underlying issue of the nurse's negative feelings.
A client, age 42, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?
- A. Onset of sporadic sexual activity at age 17
- B. Pregnancy complicated with eclampsia at
- C. Spontaneous abortion at age 19 age 27
- D. Human papilloma virus infection at age 32
Correct Answer: D
Rationale: The correct answer is D: Human papilloma virus (HPV) infection at age 32. HPV is a known risk factor for cervical cancer as it can lead to cellular changes in the cervix. Here's the rationale:
1. HPV is a sexually transmitted infection that can cause abnormal cell growth in the cervix.
2. Persistent HPV infection is a major risk factor for developing cervical cancer.
3. Age 32 is within the typical age range for HPV infection and the development of cervical cancer.
4. Choices A, B, and C are unrelated to the primary risk factor for cervical cancer, which is HPV infection.
A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary goal for this admission is education. Which of the following goals should the nurse incorporate into her teaching plan?
- A. Maintenance of blood glucose levels between 180 and 200mg/dl
- B. Smoking reduction but not complete cessation
- C. An eye examination every 2 years until age 50
- D. Exercise and a weight reduction diet
Correct Answer: D
Rationale: The correct answer is D, as exercise and a weight reduction diet are essential components in managing type 2 diabetes. Exercise helps lower blood glucose levels and improves insulin sensitivity. Weight reduction reduces insulin resistance. Choice A is incorrect because maintaining blood glucose levels between 180-200mg/dl is too high and can lead to complications. Choice B is incorrect as complete smoking cessation is crucial for overall health and diabetes management. Choice C is incorrect because eye examinations should be done annually, not every 2 years, to monitor for diabetic retinopathy. In summary, choice D is the best option as it directly addresses the management of type 2 diabetes.
The nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
- A. Duodenal ulcer
- B. Weight gain
- C. Hemorrhoids
- D. Polyps
Correct Answer: D
Rationale: The correct answer is D: Polyps. Polyps in the colon are precancerous growths that can develop into colorectal cancer over time. Identifying polyps during a medical history interview can raise suspicion for colorectal cancer due to their potential to progress into malignancy. Duodenal ulcer (A) is not directly related to colorectal cancer. Weight gain (B) is a non-specific symptom and does not specifically indicate colorectal cancer. Hemorrhoids (C) are common and usually benign, not directly linked to colorectal cancer.
While managing a client after a medical or surgical procedure for bladder stones, for what rise in the temperature should the nurse notify the physician?
- A. When the temperature rises above 101F
- B. When the temperature rises above 100F
- C. When the temperature rises above 102F
- D. When the temperature rises above 99F
Correct Answer: C
Rationale: The correct answer is C: When the temperature rises above 102F. A temperature rise above 102F is concerning as it may indicate infection or other complications post-procedure. This higher threshold helps in early detection and timely intervention. Choices A and B set lower thresholds, potentially delaying necessary medical attention. Choice D is below the typical threshold for fever and would not typically warrant physician notification in this context.