Nokea
In embryonic period, formation of all of the following occur by the given time EXCEPT
- A. 8 days - blastocyst formation
- B. 6 weeks - ectoderm formation
- C. 8 weeks - crown-rump length about 3 cm
- D. 10 weeks - endoderm formation
Correct Answer: D
Rationale: Endoderm formation occurs much earlier than 10 weeks in the embryonic period.
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A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient?
- A. A 4-year-old boy post-appendectomy surgery
- B. A 6-year-old boy with pneumonia
- C. A 15-year-old boy admitted with a vasoocclusive sickle cell crisis
- D. A 12-year-old boy with cellulitis
Correct Answer: C
Rationale: The nurse should assign the 14-year-old boy recovering from an appendectomy to Roommate C, the 15-year-old boy admitted with a vasoocclusive sickle cell crisis. This decision is based on providing similar age groups and conditions for mutual support and understanding. Both patients are teenagers and are experiencing health challenges that involve pain management and supportive care. This pairing can offer emotional and social benefits as they navigate their hospital stay together. It is important to consider factors like age, condition, and potential social interactions when assigning roommates in a healthcare setting to promote a positive environment for healing and recovery.
Which of the following statements would be most appropriate when assisting a patient who has the nursing diagnosis ofAltered Thought Process with Persona! Hygiene Needs?
- A. "What would you like to do first, brush your teeth?"
- B. "Where is y our toothbrush?"
- C. "When would you like to have your bath?"
- D. "Would you like to brush your teeth, or do you want me to do it for you? it's good to do things for yourself."
Correct Answer: D
Rationale: Option D is the most appropriate statement when assisting a patient with altered thought process and personal hygiene needs. This statement provides the patient with a choice between brushing their teeth independently or having assistance, while also emphasizing the importance of self-care activities. Offering patients choices empowers them and helps maintain their sense of autonomy, even when dealing with altered thought processes. Additionally, encouraging patients to perform activities for themselves can help improve their self-esteem and promote independence.
The nurse is teaching a class about breast self-examinations. A client asks if the she should have an annual mammogram. According to the American Cancer Society, how should the nurse respond?
- A. All women over age 30 should have an annual mammogram.
- B. All women over age 40 should have an annual mammogram.
- C. Any woman over age 20 whose mother had breast cancer should have an annual mammogram.
- D. Any woman who feels she is at risk for breast cancer should have an annual mammogram.
Correct Answer: B
Rationale: According to the American Cancer Society, they recommend that all women aged 40 to 44 should have the choice to start annual mammograms if they wish to do so. For women aged 45 to 54, it is recommended to have an annual mammogram. For women aged 55 and older, they can switch to mammograms every two years or continue with annual screenings. Mammograms are an important screening tool for detecting breast cancer early, especially in women over the age of 40 when the risk of developing breast cancer increases.
What is the last step when inserting an IV cannula?
- A. Secure the cannula with tape.
- B. Document the insertion site, date, and type of cannula used.
- C. Assess the site
- D. Place a sterile dressing over the insertion site. INFLAMMATORY AND INFECTIOUS DISTURBANCES Caring for clients with upper respiratory infections
Correct Answer: D
Rationale: The last step when inserting an IV cannula is to place a sterile dressing over the insertion site. This helps to protect the site from contamination and reduce the risk of infection. A sterile dressing also helps to maintain the integrity of the insertion site and prevent any foreign materials from entering the wound. Additionally, the dressing provides a barrier between the cannula site and the external environment, promoting healing and reducing the chance of complications.
The nurse is assessing a 3-day-old, breastfed newborn who weighed 7 pounds, 8 ounces at birth. The newborn's mother is now concerned that the newborn weighs 6 pounds, 15 ounces. Which is the most appropriate nursing intervention?
- A. Recommend supplemental feedings of formula.
- B. Explain that this weight loss is within normal limits.
- C. Assess child further to determine cause of excessive weight loss.
- D. Encourage mother to express breast milk for bottle feeding the newborn.
Correct Answer: B
Rationale: It is normal for newborns to lose weight in the first few days of life, typically up to 10% of their birth weight. In this case, the newborn's weight loss from 7 pounds, 8 ounces to 6 pounds, 15 ounces is within the expected range. It is important for the nurse to reassure the mother that this weight loss is normal and to encourage continued breastfeeding on demand to support newborn hydration and nutrition. There is no need for supplemental feedings at this point unless there are other signs of feeding issues or concerns.