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After washing her hands and gently cleaning any discharge that can be removed easily from the outer ear, Nurse Selma positions the child. Which of the following steps follows?
- A. Gently press the tragus of the ear four times in a pumping motion.
- B. Gently pull the outer ear
- C. Drop the medicine into the ear canal.
- D. Keep the ear up for five minutes.
Correct Answer: C
Rationale: The correct next step after positioning the child is to drop the medicine into the ear canal. This is typically the next step in administering ear drops for a child. The cleaning and positioning steps are to prepare the ear for receiving the medication. Dropping the medicine into the ear canal ensures that the medication can reach the affected area effectively. Once the medicine is dropped into the ear canal, it is important to follow any additional instructions provided by the healthcare provider regarding keeping the ear in a certain position or any other post-administration care steps.
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The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care?
- A. Encourage fluid
- B. Coughing and deep breathing
- C. Providing frequent oral care
- D. Monitoring red blood cell coun
Correct Answer: B
Rationale: A priority intervention for a client with multiple myeloma is to include coughing and deep breathing exercises in the plan of care. Multiple myeloma can affect the bone marrow's ability to produce healthy blood cells, including red blood cells, which can lead to anemia. Anemia can cause fatigue and shortness of breath. By encouraging coughing and deep breathing exercises, the nurse can help improve lung function, enhance oxygenation, and prevent potential respiratory complications in the client with multiple myeloma. This intervention is crucial in promoting respiratory health and overall well-being for the client.
Because of the scarcity of nurses in the hospital settings, different service delivery models were proposed. Which Situation represents the primary nursing care delivery model?
- A. The nursing aide is assigned to make beds and other errands while the nurse is to give medications.
- B. The nurse develops a plan of care for patients and collaborates with other team members.
- C. The nurse performs all tasks needed by the individual patient to optimize health .
- D. The nurse provides care to 4 patients while the nursing aide is to care for 2 patients.
Correct Answer: C
Rationale: The primary nursing care delivery model is represented by option C, where the nurse performs all tasks needed by the individual patient to optimize health. In this model, the nurse is responsible for coordinating and providing comprehensive care to a specific group of patients throughout their stay. The primary nurse establishes a close relationship with the patient and takes accountability for their care, ensuring continuity, communication, and personalized attention. This approach emphasizes the importance of the nurse-patient relationship and holistic care delivery, which can lead to improved patient outcomes and satisfaction.
A woman in active labor presents with prolonged second stage, characterized by ineffective pushing efforts and slow fetal descent. What maternal condition should the nurse assess for that may contribute to this abnormal labor pattern?
- A. Pelvic floor dysfunction
- B. Maternal fatigue
- C. Fetal macrosomia
- D. Uterine hyperstimulation
Correct Answer: A
Rationale: Pelvic floor dysfunction can contribute to a prolonged second stage of labor by impairing the ability of the woman to effectively push during contractions. This can result in inefficient pushing efforts and slow fetal descent. The nurse should assess for signs and symptoms of pelvic floor dysfunction, such as difficulty controlling bowel movements or urine leakage, as addressing this issue may help improve the progress of labor. Maternal fatigue, fetal macrosomia (larger than average baby size), and uterine hyperstimulation are other factors that can impact labor but are less likely to specifically contribute to ineffective pushing efforts and slow fetal descent in the second stage of labor.
A postpartum client reports feeling emotional and tearful despite no apparent physical discomfort. What nursing intervention should be prioritized to address the client's emotional well-being?
- A. Providing opportunities for rest and sleep
- B. Educating the client about the "baby blues" phenomenon
- C. Encouraging the client to engage in self-care activities
- D. Referring the client to a mental health professional
Correct Answer: B
Rationale: Educating the client about the "baby blues" phenomenon should be prioritized as it is a common occurrence that happens to many women after giving birth. The "baby blues" refer to feelings of sadness, irritability, and tearfulness that many new mothers experience due to hormonal changes and the stress of adjusting to motherhood. By understanding that these feelings are a normal part of the postpartum period and that they usually resolve on their own within a few weeks, the client may feel reassured and supported. Providing information and support can help the client cope with these emotions and reduce any anxiety or distress they may be feeling. If the client's emotional state does not improve or becomes more severe, further intervention such as referring to a mental health professional may be necessary. But initially, education and reassurance about the "baby blues" can be an effective nursing intervention to address the client's emotional well-being.
Which of the following dental conditions is characterized by inflammation of the gingival tissues surrounding the teeth, often caused by poor oral hygiene?
- A. Dental caries
- B. Periodontitis
- C. Dental abscess
- D. Oral candidiasis
Correct Answer: B
Rationale: Periodontitis is the dental condition characterized by inflammation of the gingival tissues surrounding the teeth. It is typically caused by poor oral hygiene practices, leading to plaque buildup and eventually gum disease. If left untreated, periodontitis can cause serious damage to the gum tissue and the underlying bones supporting the teeth, which can eventually result in tooth loss. Regular dental check-ups, proper oral hygiene habits, and professional cleanings are important for preventing and managing periodontitis.