Nokea
An older adult is diagnosed with Parkinson's disease. The client asks the nurse what causes Parkinson's disease. In addition to telling the client that we are not really sure what causes it, the nurse should include which information?
- A. There is not enough dopamine in the brain.
- B. The myelin sheath is being destroyed.
- C. There is not enough acetylcholine at the myoneural junction.
- D. There is an obstruction in the circulation of the brain.
Correct Answer: A
Rationale: Parkinson's disease results from dopamine deficiency in the basal ganglia, impairing movement, unlike myelin destruction, acetylcholine issues, or circulatory obstruction.
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The nurse is assessing a client with complaints of right lower quadrant pain.
- A. Which assessment technique should the nurse use first to assess a client with right lower quadrant pain?
- B. Inspect the abdomen for distention or masses.
- C. Auscultate the abdomen for bowel sounds.
- D. Percuss the abdomen for tympany or dullness.
- E. Palpate the abdomen for tenderness or rebound.
Correct Answer: A
Rationale: Inspection is the first step in abdominal assessment, allowing the nurse to observe for distention, masses, or visible abnormalities before proceeding to auscultation, percussion, and palpation. Palpation last prevents discomfort that could alter other findings.
The nurse is caring for a client with a history of rheumatoid arthritis.
- A. Which symptom is expected in a client with rheumatoid arthritis?
- B. Morning stiffness lasting over 30 minutes.
- C. Pain that worsens with activity.
- D. Asymmetrical joint involvement.
- E. Rapid onset of symptoms.
Correct Answer: A
Rationale: Morning stiffness lasting over 30 minutes is a hallmark of rheumatoid arthritis due to joint inflammation. Pain improves with activity, joints are symmetrically affected, and onset is gradual.
A two year-old child is brought to the provider's office with a chief complaint of mild diarrhea for two days. Nutritional counseling by the nurse should include which statement?
- A. Place the child on clear liquids and gelatin for 24 hours
- B. Continue with the regular diet and include oral rehydration fluids
- C. Give bananas, apples, rice and toast as tolerated
- D. Place NPO for 24 hours, then rehydrate with milk and water
Correct Answer: B
Rationale: Current recommendations for mild to moderate diarrhea are to maintain a normal diet with fluids to rehydrate.
When describing the correct way for cleansing a wound site, the nurse understands that the wound should be cleaned:
- A. From the top to the bottom two times, with the swab discarded
- B. From the outermost region to the center
- C. With circular motions from the drainage site to the outermost edges
- D. With normal saline followed by an astringent wash
Correct Answer: C
Rationale: Cleaning from the drainage site outward prevents spreading pathogens. Other methods risk contamination or are inappropriate.
Which statement by the nurse is appropriate when giving an assignment to an unlicensed assistive personnel (UAP) to help a client ambulate for the first time after a colon resection?
- A. Have the client sit on the side of the bed before helping the client to walk.
- B. If the client is dizzy ask the client to take some slow, deep breaths.
- C. Help the client to walk in the room as often as the client wishes.
- D. When you help the client to walk, ask if any pain occurs.
Correct Answer: A
Rationale: This statement gives clear directions to the UAP about the task and is most closely associated with the information provided in the stem that this is the client's first time out of bed after surgery.