Nokea
In a well-child clinic, the nurse examines many children daily. Which of the following toddlers requires further follow-up?
- A. A 13-month-old who is unable to walk
- B. A 20-month-old who is only using 2 and 3 word sentences
- C. A 24-month-old who cries during examination
- D. A 30-month-old who is only drinking from a sip cup
Correct Answer: D
Rationale: The correct answer is D because a 30-month-old should have developed the skill to drink from a regular cup by this age. Drinking from a sip cup at this stage may indicate a delay in development. Choices A, B, and C are not as concerning as they can be within the range of normal development. A 13-month-old not walking yet, a 20-month-old using 2 and 3 word sentences, and a 24-month-old crying during examination are all behaviors that can fall within the spectrum of typical development for their respective ages.
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What title should be given to this occupational health nurse job description? A registered nurse who establishes a provider network, recommends treatment plans that assure quality and efficacy while controlling costs, monitors outcomes, and maintains communication among all involved.
- A. manager
- B. researcher
- C. case manager
- D. health promotion specialist
Correct Answer: C
Rationale: The correct answer is C: case manager. A case manager in healthcare coordinates care, monitors outcomes, and ensures quality and cost-effectiveness. In this job description, the nurse is mainly focused on coordinating care, recommending treatment plans, monitoring outcomes, and maintaining communication among all involved, which aligns with the responsibilities of a case manager. Choices A, B, and D are incorrect because the job description does not primarily involve general management, research, or health promotion specialization.
The nurse is caring for a 75-year-old client in congestive heart failure. Which finding suggests that digitalis levels should be reviewed?
- A. Extreme fatigue
- B. Increased appetite
- C. Intense itching
- D. Constipation
Correct Answer: A
Rationale: Extreme fatigue can be a sign of digitalis toxicity, especially in older adults, and warrants a review of the client's medication levels and potential adjustment. Increased appetite, intense itching, and constipation are not typically associated with digitalis toxicity and do not directly indicate a need for a review of digitalis levels.
Statistics of illnesses are termed as:
- A. Vital statistics
- B. Morbidity
- C. Statistics
- D. Mortality
Correct Answer: B
Rationale: The correct answer is B: 'Morbidity.' Morbidity specifically refers to the statistics of illnesses, encompassing the incidence, prevalence, and duration of disease within a population. Choice A, 'Vital statistics,' typically refers to data on births, deaths, marriages, and divorces. Choice C, 'Statistics,' is a broad term encompassing the collection, analysis, interpretation, and presentation of numerical data. Choice D, 'Mortality,' specifically refers to the state of being subject to death or the number of deaths in a given population.
While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?
- A. Check vital signs
- B. Massage the fundus
- C. Offer a bedpan
- D. Check for perineal lacerations
Correct Answer: B
Rationale: The correct action for the nurse to take when encountering a boggy uterus and vaginal bleeding after delivery is to massage the fundus. Massaging the fundus helps the uterus contract, which can reduce vaginal bleeding. Checking vital signs may be important but addressing the uterine atony and bleeding takes precedence. Offering a bedpan or checking for perineal lacerations are not the immediate actions needed to manage postpartum hemorrhage.
A newborn presents with a pronounced cephalic hematoma following a birth in the posterior position. Which nursing diagnosis should guide the plan of care?
- A. Pain related to periosteal injury
- B. Impaired mobility related to bleeding
- C. Parental anxiety related to knowledge deficit
- D. Injury related to intracranial hemorrhage
Correct Answer: C
Rationale: The correct nursing diagnosis to guide the plan of care for a newborn with a pronounced cephalic hematoma following a birth in the posterior position is 'Parental anxiety related to knowledge deficit.' This is appropriate because the parents may be worried about the appearance and potential complications of the cephalic hematoma. They may require education and reassurance from the nurse. Choices A, B, and D are incorrect because they do not address the emotional needs of the parents and the knowledge deficit they may have regarding the condition.