Nokea
In conducting a cleansing enema, how does the nurse position the client?
- A. Right lateral position
- B. Left lateral position
- C. Right Sim's position
- D. Left Sim's position
Correct Answer: B
Rationale: In preparing a patient for a cleansing enema, the nurse typically positions the patient in the left lateral position. This position allows for the best flow of the solution due to the anatomical configuration of the colon. The right lateral position, right Sim's position, and left Sim's position are not typically used for this procedure. The rationale provided initially is incorrect as it pertains to lung expansion and postural drainage, which are not relevant to a cleansing enema procedure.
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Theresa, a mother with a 2-year-old daughter, asks, 'At what age can I start taking my daughter's blood pressure as a routine procedure, since hypertension is common in our family?' What would your answer be?
- A. At 2 years old, you may
- B. As early as 1 year old
- C. When she's 3 years old
- D. When she's 6 years old
Correct Answer: D
Rationale: Regular blood pressure checks generally start from age 3, but in the case of a family history of hypertension, they should start when the child is around 6 years old. This is because the readings will be more reliable and indicative of the child's health condition at this age. The other options are incorrect because they suggest earlier ages for routine blood pressure checks. While blood pressure can be measured at any age, it is not typically included as part of a routine health check-up for very young children unless there are specific health concerns.
Generally, lifestyle-related diseases share common risk factors. Which of the following is NOT one of them?
- A. Physical activity
- B. Smoking
- C. Genetics
- D. Nutrition
Correct Answer: C
Rationale: Common risk factors for lifestyle-related diseases typically include aspects of one's lifestyle that can be modified or controlled, such as physical activity, smoking habits, and nutrition. These factors can be changed to prevent or manage lifestyle-related diseases. Genetics, on the other hand, is not a modifiable risk factor, meaning it cannot be changed or controlled. Therefore, it is not considered a common risk factor for lifestyle-related diseases. Understanding the modifiable risk factors for these diseases allows for better prevention and management strategies, and helps reduce the risk of complications.
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.
Which of the following terms refers to a process by which an individual receives education about the recognition of stress reactions and management strategies for handling stress, which may be instituted after a disaster?
- A. Critical incident stress management
- B. Follow-up
- C. Debriefing
- D. Defusion
Correct Answer: A
Rationale: Critical incident stress management is a process that provides individuals with education about recognizing stress reactions and strategizing management techniques for handling stress after a disaster. Choice B, 'Follow-up', is incorrect because it generally refers to continuing care after initial treatment, not specifically to stress management education. Choice C, 'Debriefing', is a process where individuals involved in a critical event are brought together to discuss the event and their reactions to it. It can be part of the critical incident stress management process, but it doesn't cover the whole process. Choice D, 'Defusion', is a technique used in the immediate aftermath of a traumatic event to help individuals process their experiences, but it does not encompass the full range of education about stress recognition and management strategies.
What is considered fast breathing in a 13-month-old child if the respiratory rate (RR) exceeds which value?
- A. 40 breaths per minute
- B. 50 breaths per minute
- C. 60 breaths per minute
- D. 30 breaths per minute
Correct Answer: C
Rationale: In the context of pediatric care, a respiratory rate of more than 60 breaths per minute in a child aged 13 months is considered fast breathing, hence option 'C' is correct. Options 'A', 'B', and 'D' are incorrect as they do not meet the specified criteria for fast breathing in a 13-month-old. Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, including monitoring respiratory rates, to ensure that interventions are appropriately targeted and outcomes are optimized.