Nokea
According to Bowen's theoretical approach to therapy,which of the following should the nurse recognize as a concept of a functional family interaction pattern?
- A. Marital skew
- B. Sibling position
- C. Double-bind communication
- D. Pseudomutuality
Correct Answer: B
Rationale: According to Bowen's theoretical approach, sibling position is a concept of a functional family interaction pattern. This refers to the role and position each sibling holds within the family system, influencing their behavior and relationships. Understanding sibling positions helps assess family dynamics and interactions. Marital skew, double-bind communication, and pseudomutuality are not specific concepts of a functional family interaction pattern in Bowen's theory. Marital skew refers to imbalance in spousal relationships, double-bind communication involves conflicting messages, and pseudomutuality is a false sense of harmony.
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Administer Dopamine 3 mcg/kg/min. The client weighs 176 pounds. The drug is available as 500 mg in 250 mL of fluid. Calculate mcg/min, mcg/hr, and mL/hr. (Do not round your answer and include unit of measure with each answer)
Correct Answer: 7.2
Rationale: To calculate the correct answer, first convert the client's weight from pounds to kilograms (176 lb / 2.2 = 80 kg). Then, calculate the total dose per minute (3 mcg/kg/min * 80 kg = 240 mcg/min). Next, calculate the total dose per hour (240 mcg/min * 60 min = 14,400 mcg/hr). Finally, determine the mL/hr by dividing the total dose per hour by the concentration of the drug (14,400 mcg/hr / 500 mg in 250 mL = 28.8 mL/hr). Therefore, the correct answer is 240 mcg/min, 14,400 mcg/hr, and 28.8 mL/hr. Other choices are incorrect as they do not follow the proper conversion and calculation steps.
A nurse is caring for a client who has late-stage Alzheimer's disease and is hospitalized for treatment of the flu. During the night shift,the client is found climbing into the bed of another client who becomes upset and scared. Which of the following actions should the nurse take?
- A. Medicate the patient with antipsychotics.
- B. Assist the client to the correct room.
- C. Move the client to a room at the end of the hall.
- D. Place the client in restraints.
Correct Answer: B
Rationale: The correct answer is B: Assist the client to the correct room. This is the appropriate action as it addresses the immediate issue of the client being in the wrong room, which is causing distress to the other client. Moving the client to the correct room ensures safety and comfort for both clients. Medicating with antipsychotics (choice A) is not the first-line intervention in this situation and should be avoided unless absolutely necessary due to potential side effects. Moving the client to a room at the end of the hall (choice C) may not address the underlying issue and can isolate the client unnecessarily. Placing the client in restraints (choice D) should be avoided as it can be traumatic and is not indicated in this scenario.
A nurse is assessing a school-age child who recently loaded a virus onto their teacher's computer after receiving a poor grade on a science project. The child's guardian tells the nurse their child often bullies the other kids at school. Which of the following diagnoses should the nurse expect?
- A. Oppositional defiant disorder (ODD)
- B. Attention deficit hyperactivity disorder (ADHD)
- C. Intermittent explosive disorder (IED)
- D. Conduct disorder (CD)
Correct Answer: D
Rationale: Correct Answer: D - Conduct disorder (CD)
Rationale:
1. Conduct disorder involves a pattern of behavior that violates the basic rights of others or societal norms.
2. The child's actions of loading a virus onto the teacher's computer and bullying classmates indicate a disregard for rules and the well-being of others.
3. Conduct disorder commonly presents with aggression, deceitfulness, and violation of rules.
4. These behaviors are more severe than those seen in Oppositional Defiant Disorder (A) and Attention Deficit Hyperactivity Disorder (B).
5. Intermittent Explosive Disorder (C) typically involves impulsive aggression, not premeditated actions like intentionally loading a virus.
6. Conduct disorder is the most appropriate diagnosis considering the child's behavior towards others.
Summary:
- A: Oppositional Defiant Disorder - less severe, lacks the pattern of aggression seen in the child's behavior.
- B: Attention Deficit Hyperactivity Disorder - does not fully capture the intentional harmful behavior
A nurse is performing an admission assessment on a client who has been diagnosed with schizophrenia. Which of the following findings should the nurse identify as a negative symptom?
- A. Bizarre behavior
- B. Waxy flexibility
- C. Somatic delusions
- D. Illogicality
Correct Answer: B
Rationale: Waxy flexibility reflects a lack of normal movement a negative symptom of schizophrenia.
A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?
- A. Hyperextend the client's neck.
- B. Instruct the client to deep breathe every 4 hr.
- C. Place the head of the client's bed in the flat position.
- D. Check the client's voice every 2 hr.
Correct Answer: B,D
Rationale: The correct answers are B and D. Instructing the client to deep breathe every 4 hours helps prevent respiratory complications post-thyroidectomy. Checking the client's voice every 2 hours is important to monitor for vocal cord damage, a potential complication. Choice A is incorrect as hyperextending the client's neck can put strain on the surgical site. Choice C is incorrect as the head of the bed should be elevated to reduce swelling and promote drainage.