During blood administration, what is essential for the nurse to do in order to carefully monitor for adverse reactions?
- A. Stay with the client for the first 15 minutes of blood administration
- B. Stay with the client for the entire period of blood administration
- C. Run the infusion at a faster rate during the first 15 minutes
- D. Inform the client to notify the staff immediately for any adverse reaction
Correct Answer: A
Rationale: In the context of blood administration, it's crucial for the nurse to stay with the client for the first 15 minutes. This is because most adverse reactions are likely to occur within this initial period. Monitoring the client closely during this time allows for immediate detection and response to any potential reactions. Choice B, staying with the client for the entire period of blood administration, is not typically feasible or necessary, although regular checks should be conducted. Running the infusion at a faster rate during the first 15 minutes (Choice C) is incorrect as this can actually increase the risk of adverse reactions. Informing the client to notify the staff immediately for any adverse reaction (Choice D) is an important practice, but it is not the most direct way for the nurse to monitor for adverse reactions.
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What characterizes Obsessive Compulsive Disorder?
- A. Uncontrollable impulse to perform an act or ritual repeatedly
- B. Persistent thoughts and behavior
- C. Recurring unwanted and disturbing thoughts
- D. Pathological persistence of unwilled thoughts
Correct Answer: A
Rationale: Obsessive Compulsive Disorder (OCD) is characterized by the uncontrollable impulse to perform an act or ritual repeatedly (Choice A). This is driven by recurring unwanted and disturbing thoughts (Choice C), but the distinguishing factor is the compulsive behavior, making choice A the most accurate. While choice B can be seen as true, it lacks the specific detail of the compulsive behavior that makes A a better answer. Choice D is not incorrect, but it uses terminology that is less precise and less commonly used to describe OCD, making it a less accurate choice than A. The provided rationale is not relevant to the question.
When is infertility said to exist?
- A. When a woman has no uterus
- B. When a woman has no children
- C. When a couple has been trying to conceive for 1 year without success
- D. When a couple has desired a child for 6 months
Correct Answer: C
Rationale: Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. Therefore, the correct answer is C. A, B, and D are incorrect. While having no uterus (choice A) may result in infertility, it is not the sole determining factor. Similarly, not having children (choice B) does not automatically indicate infertility. Lastly, the time frame of 6 months (choice D) is not sufficient to determine infertility; typically, a year of trying without success is required for such a diagnosis.
Which of the following interventions should be considered the highest priority when caring for June, who has hemiparesis secondary to a stroke?
- A. Position June in an upright lateral position
- B. Perform range of motion exercises
- C. Apply antiembolic stockings
- D. Use hand rolls or pillows for support
Correct Answer: C
Rationale: The correct answer is C, 'Apply antiembolic stockings'. In the case of a patient who has experienced a stroke and is suffering from hemiparesis, the highest priority intervention is to prevent further complications such as deep vein thrombosis (DVT), which can be life-threatening. Antiembolic stockings are used to increase venous blood flow velocity and reduce the risk of DVT. Choice 'A', positioning June in an upright lateral position, while important for overall care, is not the highest priority. Choice 'B', performing range of motion exercises, is an important part of recovery but not the immediate priority. Choice 'D', using hand rolls or pillows for support, is also a valuable intervention but does not address the most pressing risk of further complications.
Which breakfast items indicate an understanding of foods high in antioxidants A and C?
- A. Fried eggs, sausage, and whole wheat toast
- B. Oatmeal with blueberries and coffee
- C. Cereal with strawberries and low-fat milk
- D. Hard-boiled eggs, cantaloupe, and orange juice
Correct Answer: D
Rationale: The correct answer is D: Hard-boiled eggs, cantaloupe, and orange juice. Cantaloupe and orange juice are rich in vitamins A and C, which are known for their antioxidant properties. Choice A is incorrect because fried eggs, sausage, and whole wheat toast do not contain high levels of antioxidants A and C. Choice B is incorrect because, while blueberries are high in antioxidants, coffee does not provide significant amounts of vitamins A and C. Choice C is incorrect because, although strawberries are a good source of vitamin C, low-fat milk does not contribute significantly to vitamins A and C.
Which adolescent student lunch, evaluated by the school nurse, is the least nutritious?
- A. Ham sandwich, apple, and milk
- B. Hamburger, fries, and soft drink
- C. Macaroni and cheese, green beans, and peaches
- D. Meatloaf, broccoli, and pear slices
Correct Answer: B
Rationale: The correct answer is B: Hamburger, fries, and soft drink. This meal is considered the least nutritious among the options provided due to its high content of unhealthy fats, processed carbohydrates, and added sugars, which lack essential nutrients. On the other hand, choice A: Ham sandwich, apple, and milk, offers a balanced meal with protein, fiber, vitamins, and calcium. Choice C: Macaroni and cheese, green beans, and peaches, provides a mixture of carbohydrates, vegetables, and fruits. Choice D: Meatloaf, broccoli, and pear slices, includes protein, fiber, and vitamins. Thus, all choices except B provide a more balanced and nutritious meal.