Nokea
A resident brings several electronic devices to a nursing home. One of the devices has a two-pronged plug. What rationale should the nurse provide when explaining why an electrical device must have a three-pronged plug?
- A. Controls stray electrical currents.
- B. Promotes efficient use of electricity.
- C. Shuts off the appliance if there is an electrical surge.
- D. Divides the electricity among the appliances in the room.
Correct Answer: A
Rationale: A three-pronged plug functions as a ground to dissipate stray electrical currents. This helps prevent electrical shocks and ensures the safety of the user. Choice B is incorrect because the number of prongs on a plug does not impact the efficient use of electricity. Choice C is incorrect because a three-pronged plug does not shut off the appliance during an electrical surge; that role is typically fulfilled by surge protectors. Choice D is incorrect as a three-pronged plug does not divide electricity among appliances in a room; it primarily serves as a safety measure to handle excess electrical currents.
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A 75-year-old client, hospitalized with a cerebral vascular accident (stroke), becomes disoriented at times and tries to get out of bed but is unable to ambulate without help. What is the most appropriate safety measure?
- A. Restrain the client in bed
- B. Ask a family member to stay with the client
- C. Check the client every 15 minutes
- D. Use a bed exit safety monitoring device
Correct Answer: D
Rationale: Option D is the most appropriate safety measure in this scenario. Using a bed exit safety monitoring device allows the client to retain some independence while ensuring that the nursing staff is alerted when assistance is needed. This solution promotes client safety without compromising their autonomy. Option A, restraining the client in bed, can lead to increased agitation, confusion, and a loss of independence. Option B, asking a family member to stay with the client, shifts the responsibility away from the healthcare team. Option C, checking the client every 15 minutes, is not a sufficient safety measure as the client could attempt to get out of bed in the unobserved interval, risking falls and injury.
To properly read a meniscus,
- A. hold the measuring device at eye level and read the bottom of the curve of the liquid level
- B. hold the measuring device at eye level and read the top of the curve of the liquid level where the liquid adheres to the walls of the container.
- C. hold the measuring device at table level and, looking down into the measuring device, read the bottom of the curve of the liquid level.
- D. hold the measuring device at table level and, looking down into the measuring device, read the top of the curve of the liquid level.
Correct Answer: A
Rationale: To properly read a meniscus, it is essential to hold the measuring device at eye level to avoid parallax error. Reading the bottom of the curve of the liquid level is correct because the meniscus is the concave or convex curve at the liquid's surface. Choice B is incorrect because reading the top of the curve where the liquid adheres to the walls of the container can lead to inaccurate measurements. Choices C and D are incorrect as they suggest holding the device at table level, which can introduce parallax error and result in an incorrect reading.
During a general survey of a patient, which finding is considered normal?
- A. Body mass index (BMI) of 20.
- B. When standing, the patient's base is narrow.
- C. The patient appears older than their stated age.
- D. Arm span (fingertip to fingertip) is greater than the height.
Correct Answer: A
Rationale: A body mass index (BMI) of 20 is considered normal as the range for a normal BMI is between 19-24. When standing, a patient's base should be wide for stability and proper weight distribution. An older appearance than the stated age may indicate a history of chronic illness or chronic alcoholism. In a general survey, the patient's arm span (fingertip to fingertip) should approximately equal the patient's height. An arm span greater than the height may suggest Marfan syndrome. Therefore, the correct choice is a normal BMI of 20, which falls within the healthy range. Choices B, C, and D all describe abnormal findings that may indicate underlying health conditions or syndromes.
When caring for a patient with latex allergy, the healthcare provider creates a latex-safe environment by doing which of the following?
- A. Carefully cleaning the wall-mounted blood pressure device before using it.
- B. Donning latex gloves outside the room to limit powder dispersal.
- C. Using a latex-free pharmacy protocol.
- D. Placing the patient in a semi-private room.
Correct Answer: C
Rationale: Creating a latex-safe environment for a patient with latex allergy is crucial to prevent allergic reactions. Using a latex-free pharmacy protocol is essential as it ensures that medications and supplies provided to the patient are free of latex components. Cleaning a wall-mounted blood pressure device may not be sufficient as the device itself may contain latex parts that can trigger an allergic reaction. Donning latex gloves, even outside the room, is not recommended as powder dispersal can cause issues; only non-latex gloves should be used in a latex-safe environment. Placing the patient in a semi-private room does not directly address the need to eliminate latex exposure from medical supplies and equipment, which is better achieved through a latex-free pharmacy protocol.
Which of the following tests would MOST LIKELY be performed on a patient who is being monitored for coagulation therapy?
- A. PT/INR
- B. CBC
- C. PTT
- D. WBC
Correct Answer: A
Rationale: The correct answer is A: PT/INR. Prothrombin times (PT/INR) are commonly used to monitor patients on Coumadin (warfarin) therapy, an anticoagulant that slows the blood's ability to clot. Monitoring PT/INR levels helps ensure the patient is receiving the appropriate dosage of Coumadin. Choice B, CBC (Complete Blood Count), is a general test that provides information on red blood cells, white blood cells, and platelets but is not specific to monitoring coagulation therapy. Choice C, PTT (Partial Thromboplastin Time), is another coagulation test but is not as commonly used for monitoring Coumadin therapy. Choice D, WBC (White Blood Cell count), is unrelated to monitoring coagulation therapy and is used to assess immune system function.