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During a community health fair, the nurse conducts a blood pressure screening for a 60-year-old woman who has a blood pressure of 160/100 mm Hg. What should the nurse do first?
- A. Instruct the client to monitor her blood pressure at home
- B. Refer the client to her healthcare provider for further evaluation
- C. Educate the client on lifestyle changes to reduce blood pressure
- D. Recheck the blood pressure in 15 minutes
Correct Answer: B
Rationale: When encountering a high blood pressure reading at a community health fair, it is essential for the nurse to refer the client to her healthcare provider for further evaluation. This step ensures that the client receives a comprehensive assessment, diagnosis, and appropriate management plan. In this scenario, it is crucial to prioritize professional evaluation over self-monitoring, lifestyle education, or immediate rechecking of the blood pressure. Referral to a healthcare provider allows for timely intervention and ongoing monitoring of the client's blood pressure to prevent potential complications.
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A client with a history of alcoholism is admitted with pancreatitis. Which assessment finding is most important for the nurse to report to the healthcare provider?
- A. Nausea and vomiting.
- B. Epigastric pain radiating to the back.
- C. Temperature of 102°F (38.9°C).
- D. Mild jaundice.
Correct Answer: C
Rationale: A temperature of 102°F (38.9°C) is the most important assessment finding to report to the healthcare provider in a client with pancreatitis and a history of alcoholism. Fever in this context can indicate infection, which is a serious complication requiring immediate intervention. Nausea and vomiting (choice A) are common symptoms of pancreatitis but may not require immediate intervention unless severe. Epigastric pain radiating to the back (choice B) is a classic symptom of pancreatitis and should be addressed, but a fever takes precedence. Mild jaundice (choice D) may be present in pancreatitis but is not as urgent as a high temperature signaling possible infection.
A public health nurse is working with a community to improve access to dental care. Which intervention is most likely to be effective?
- A. Setting up dental clinics in accessible locations
- B. Distributing flyers with information about dental services
- C. Offering transportation vouchers for dental appointments
- D. Partnering with local businesses to promote dental health
Correct Answer: A
Rationale: Setting up dental clinics in accessible locations is the most effective intervention to improve access to dental care. By having dental clinics in easily reachable places, community members are more likely to seek and utilize dental services. Distributing flyers may raise awareness, but it may not address the issue of physical accessibility to dental care. Offering transportation vouchers could help with transportation barriers but might not address the core issue of proximity to dental services. Partnering with local businesses to promote dental health is a good initiative, but it may not directly improve access to dental care as setting up clinics in accessible locations would.
The healthcare provider is conducting a health assessment for a family in a rural area. Which intervention should the healthcare provider prioritize to address the family's health needs?
- A. Providing information on local healthcare resources
- B. Teaching the family about proper nutrition
- C. Assisting the family in scheduling medical appointments
- D. Connecting the family with transportation services
Correct Answer: A
Rationale: In rural areas, access to healthcare may be limited. Providing information on local healthcare resources is essential to ensure the family can access necessary services. While proper nutrition (choice B) and medical appointments (choice C) are important, having access to healthcare resources is fundamental. Transportation services (choice D) may be helpful but addressing the availability of healthcare resources should be the priority.
During the physical assessment, which finding should the nurse recognize as a normal finding?
- A. Regular pulsation at the epigastric area when the client is supine.
- B. A loud, harsh murmur at the second right intercostal space.
- C. Dullness over the lung fields.
- D. Increased tactile fremitus.
Correct Answer: A
Rationale: The regular pulsation at the epigastric area when the client is supine is a normal finding. This phenomenon is caused by the regular and recurrent expansion and contraction of an artery due to waves of pressure caused by the ejection of blood from the left ventricle. Choices B, C, and D describe abnormal findings during a physical assessment. A loud, harsh murmur at the second right intercostal space indicates an abnormal heart sound, dullness over the lung fields may suggest consolidation or fluid in the lungs, and increased tactile fremitus can be a sign of lung consolidation or pathology.
The nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease (COPD). Which statement by the client indicates a need for further teaching?
- A. I will use my albuterol inhaler before exercising.
- B. I will avoid secondhand smoke.
- C. I will get a flu shot every year.
- D. I will limit my fluid intake to 2 liters per day.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.