Nokea
An 8-year-old admitted with an upper-respiratory infection has an order for O2 saturation via pulse oximeter. To ensure an accurate reading, the nurse should:
- A. Place the probe on the child's abdomen
- B. Recalibrate the oximeter at the beginning of each shift
- C. Apply the probe and wait 15 minutes before obtaining a reading
- D. Place the probe on the child's finger
Correct Answer: D
Rationale: Placing the pulse oximeter probe on the finger ensures an accurate oxygen saturation reading in an 8-year-old, as peripheral sites like fingers provide reliable arterial pulsation data. The abdomen isn't suitable, recalibration isn't routine, and waiting 15 minutes delays care unnecessarily. Nurses use this technique for quick, precise monitoring, critical in respiratory infections to guide oxygen therapy.
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Which of the following statement best describe battery in nursing?
- A. A verbal threat
- B. Unconsented physical contact
- C. A legal fine
- D. A care plan
Correct Answer: B
Rationale: Battery is unconsented physical contact (B), per law e.g., touching without permission. Not threat (A, assault), not fine (C), not plan (D) contact-based. B best defines battery's violation, like touching Mr. Gary against will, making it correct.
A client has a Staphylococcus infection in a decubitus ulcer. In this case, Staphylococcus is the:
- A. Host
- B. Agent
- C. Environment
- D. Disease
Correct Answer: B
Rationale: In the Agent-Host-Environment Model, Staphylococcus is the agent the causative factor triggering illness, here infecting a decubitus ulcer. The client is the host, whose skin integrity and immunity determine susceptibility. The environment bedridden conditions or hygiene sets the stage for infection. The disease is the resulting pathology, like the ulcer's worsening. This model dissects causation: Staphylococcus (bacteria) invades the host (client) in a conducive environment (immobility), driving nursing interventions cleaning wounds, repositioning to disrupt the triad. Understanding the agent's role guides targeted care, like antibiotics, breaking the infection cycle. It's a practical lens for nurses, pinpointing external triggers to prevent or manage illness effectively, especially in chronic wound scenarios.
Which of the following statement best describe beneficence?
- A. Doing good for the client
- B. Fairness and equality
- C. Respecting client's decision
- D. Keeping promises
Correct Answer: A
Rationale: Beneficence is doing good for the client (A), per ethics acting in their best interest (e.g., pain relief). Fairness (B) is justice, decision respect (C) autonomy, promises (D) fidelity. A best captures beneficence's intent, making it correct.
The nurse does not take shortcuts for example failing to identify a client when administering medications. This is an example of critical thinking attitude:
- A. Responsibility and accountability
- B. Thinking independently
- C. Fairness
- D. Discipline
Correct Answer: A
Rationale: Responsibility and accountability as a critical thinking attitude mean adhering to standards and owning outcomes, like verifying a client's identity before medication to ensure safety. This reflects duty to the patient and profession, avoiding errors (e.g., wrong patient dosing). Thinking independently involves personal judgment, not just following protocol, which this nurse does by sticking to rules. Fairness ensures impartiality, not directly tied to identification steps. Discipline implies consistency, overlapping with responsibility, but lacks accountability's emphasis on answerability. By not cutting corners, the nurse upholds ethical and safety standards, embodying responsibility and accountability, critical for trust and precision in medication administration, a high-stakes nursing task.
The nurse is caring for an elderly woman who has had a fractured hip repaired. In the first few days following the surgical repair, which of the following nursing measures will best facilitate the resumption of activities for this client?
- A. Arranging for the wheelchair
- B. Asking her family to visit
- C. Assisting her to sit out of bed in a chair qid
- D. Encouraging the use of an overhead trapeze
Correct Answer: D
Rationale: The trapeze promotes upper body strength and mobility, aiding recovery.