Nokea
A school nurse is implementing health screening. Which of the following assessment findings should the nurse recognize as the highest priority?
- A. A child who has a BMI of 18
- B. An adolescent who has scoliosis
- C. An adolescent who has psoriasis
- D. A child who has nits
Correct Answer: B
Rationale: The correct answer is B: An adolescent who has scoliosis. Scoliosis is a spinal deformity that can progress and cause serious health issues if left untreated. The school nurse should prioritize this assessment finding to ensure early detection and appropriate interventions to prevent further complications. A: A child with a BMI of 18 may indicate underweight but is not as urgent as scoliosis. C: Psoriasis is a skin condition that may require management but is not immediately life-threatening. D: Nits (lice eggs) are a common issue but do not pose a significant health risk compared to scoliosis.
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A parish nurse is counseling a family following a client's recent diagnosis of heart disease. Which of the following actions should the nurse take first?
- A. Discuss the benefits of eating a well-balanced diet with the client's family
- B. Assist the client and the client's partner with finding an affordable exercise program
- C. Offer to accompany the client and the client's partner during health care provider visits
- D. Ask family members about the impact of the disease on relationships within the family
Correct Answer: D
Rationale: The correct answer is D: Ask family members about the impact of the disease on relationships within the family. This is the first action the nurse should take because understanding the family dynamics and relationships can provide valuable insight into how the diagnosis is affecting everyone involved. By assessing the impact on relationships, the nurse can better tailor interventions to support the entire family unit and address any emotional or communication challenges that may arise.
Option A is incorrect as discussing diet benefits should come after assessing the family dynamics. Option B is incorrect because addressing exercise programs should also come after understanding the family's needs. Option C is incorrect as accompanying to provider visits is important but not the first priority.
A community health nurse is working with a group of clients. The nurse practices the ethical principle of distributive justice by performing which of the following tasks?
- A. Keeping a promise to visit a client who is housebound after the delivery of care.
- B. Ensuring that a client who is homeless receives preventive medical care.
- C. Being honest with the parents of a child about the need to report suspected abuse.
- D. Accepting the decision of an older adult client to live alone in her home.
Correct Answer: B
Rationale: The correct answer is B because distributive justice involves fair distribution of resources and benefits in society. By ensuring that a homeless client receives preventive medical care, the nurse is promoting fairness and equitable access to healthcare services for all individuals, regardless of their social status. This action aligns with the principle of distributive justice by addressing the healthcare needs of a vulnerable population.
Keeping a promise to visit a housebound client (A) demonstrates fidelity rather than distributive justice. Being honest about reporting suspected abuse (C) is related to veracity and duty to protect vulnerable individuals. Accepting the decision of an older adult to live alone (D) is more about respecting autonomy and independence.
A nurse is counseling a client who has a new diagnosis of chlamydia. Which of the following information should the nurse include in the teaching? (Select all that apply)
- A. You should avoid sexual contact until therapy is complete
- B. Notify anyone with whom you have had sexual contact over the past 2 months
- C. You will need to take an antiviral medication for 30 days
- D. Once you complete treatment, you will have an acquired immunity against chlamydia
- E. You might experience painful urination until the infection has resolved
Correct Answer: A, B, E
Rationale: The correct answers are A, B, and E. A is correct because avoiding sexual contact until therapy is complete helps prevent spreading chlamydia to others. B is correct as notifying sexual contacts allows for their treatment to prevent reinfection. E is correct because painful urination is a common symptom of chlamydia and should be expected until treatment resolves the infection. Choice C is incorrect because chlamydia is a bacterial infection, not a viral one, so antibiotics are used, not antivirals. Choice D is incorrect because completing treatment does not confer immunity against chlamydia; reinfection is possible.
A nurse is serving on a state task force for disaster planning. The nurse is engaging in disaster preparedness efforts when performing which of the following actions?
- A. Implementing a disaster triage plan with a local medical facility
- B. Functioning as a manager at a temporary shelter
- C. Assisting with the identification of a biological agent
- D. Organizing a mass casualty drill for community members
Correct Answer: D
Rationale: The correct answer is D: Organizing a mass casualty drill for community members. This is the correct action for disaster preparedness as it helps in testing response procedures and identifying areas for improvement. Implementing a disaster triage plan (A) is important but doesn't involve community participation. Functioning as a manager at a temporary shelter (B) is a crucial role during a disaster but doesn't directly relate to preparedness efforts. Assisting with the identification of a biological agent (C) is more about response to an ongoing disaster rather than preparedness. Overall, organizing a mass casualty drill involves proactive planning and community involvement, making it the most suitable choice for disaster preparedness efforts.
A community health nurse is caring for a client in a culturally diverse community. Which of the following actions demonstrates accurate cultural knowledge about a specific cultural group?
- A. Touching the hair of an African American client during an assessment
- B. Offering to shake hands when meeting an Asian client of the opposite gender
- C. Maintaining eye contact when interviewing a Native American client
- D. Including both hot and cold food items from a Hispanic client's menu
Correct Answer: D
Rationale: The correct answer is D because it shows respect for the Hispanic client's cultural dietary preferences. In Hispanic culture, hot and cold foods are believed to have different properties that can affect health. By including both options on the menu, the nurse demonstrates understanding and acceptance of this cultural belief. Touching the hair of an African American client (A) can be considered intrusive and disrespectful. Offering to shake hands with an Asian client of the opposite gender (B) may not be culturally appropriate in some Asian cultures due to gender norms. Maintaining eye contact with a Native American client (C) may be perceived as disrespectful as some Native American cultures view direct eye contact as confrontational.