Nokea
A nurse is screening patients for immunizations. Which of following is not a contraindication for immunization?
- A. Seizures
- B. Fever >3 days
- C. Malignancy >3 months
- D. Illness >6 months
Correct Answer: D
Rationale: Chronic conditions are not considered a contraindication for immunization.
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A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?
- A. Adaptation Model
- B. Stimulus-Based Model
- C. Transaction-Based Model
- D. Selye's Model of Stress
Correct Answer: C
Rationale: The Transaction-Based Model is, according to R.S. Lazarus, a state that Stimulus theory and Response theory do not consider individual differences. He takes into account cognitive processes that intervene between the encounter and the reaction and the factors that affect the nature of this process. He includes mental and psychological components or responses as part of his concept of stress (Person-Environment Transactions).
When discussing possible complications of pregnancy with a client, the nurse should explain that all of the following are symptoms of urinary tract infection (UTI). Which of the following is least indicative of UTI during pregnancy?
- A. low-back pain
- B. urinary frequency
- C. GI distress
- D. malaise
Correct Answer: B
Rationale: Urinary frequency is least indicative of UTI during pregnancy because it is a common minor discomfort of pregnancy and is caused by pressure of the growing uterus on the bladder. As the uterus rises in the second trimester, there are no problems. Frequency returns in the third trimester when the uterus drops into the pelvic cavity. A UTI has the symptoms of frequency, back pain, supra pubic discomfort, and malaise and is diagnosed by laboratory findings.
A family member of a client with a diagnosis of Schizophrenia asks about the prognosis. The nurse's response is based on the knowledge that schizophrenia:
- A. affects women more often than men.
- B. is usually diagnosed between the ages of 15 and 45.
- C. is a chronic, deteriorating disease with periods of remission.
- D. is diagnosed later in women due to a protective hormone effect.
Correct Answer: C
Rationale: Although all of the choices are true about schizophrenia, only Choice 3 answers the question asked.
A nurse is returning phone calls in a pediatric clinic. Which of the following reports most requires the nurse's immediate attention and phone call?
- A. A 8 year-old boy has been vomiting and appears to have slower movements and has a history of an atrioventricular shunt placement.
- B. A 10 year-old girl feels a dull pain in her abdomen after doing sit-ups in gym class.
- C. A 7 year-old boy has been having a low fever and headache for the past 3 days that has history of an anterior knee wound.
- D. A 7 year-old girl that had a cast on her right ankle is complaining of itching.
Correct Answer: A
Rationale: The shunt may be blocked and require immediate medical attention.
A client recently lost a child due to poisoning. The client tells the nurse, 'I don't want to make any new friends right now.' This is an example of which of the following indicators of stress?
- A. emotional behavioral indicator
- B. spiritual indicator
- C. sociocultural indicator
- D. intellectual indicator
Correct Answer: C
Rationale: The client's withdrawal from forming new relationships reflects a sociocultural indicator of stress, as it affects social interactions. Emotional behavioral indicators involve mood changes, spiritual indicators relate to existential concerns, and intellectual indicators involve cognitive difficulties.