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In helping Mrs. Iris plan her diet, which of the following foods would the nurse help her to select?
- A. Chicken
- B. Milk
- C. Ice cream
- D. Cheese
Correct Answer: A
Rationale: Protein-rich foods like chicken aid in healing and recovery.
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A cylinder cast needs to be applied to a client with a fracture. What is the role of the nurse during the procedure?
- A. Gently massage the arm or the leg.
- B. Hold the arm or the leg in place.
- C. Provide intense heat or a cast dryer to speed the evaporation.
- D. Compress the cast on a hard surface for better support.
Correct Answer: B
Rationale: Holding the limb in place ensures proper alignment during casting.
How can the nurse examine the client for stiffness and rigidity of the neck?
- A. By positioning the client flat on the bed for at least three hours.
- B. By moving the head and chin of the client towards the chest.
- C. By asking the client to bend and pick up small and large objects on the floor.
- D. By introducing a painful stimulus on the neck.
Correct Answer: B
Rationale: This movement checks for neck stiffness indicative of neurological issues.
An alternative approach to dealing with attention deficits is not to try and improve attention itself, but to provide the client with some compensatory skills that will allow them to effectively manage their slowed information processing. This is knwn as:
- A. Information processing management (IPM).
- B. Time pressure management (TPM).
- C. Compensatory time management.
- D. Productive processing management (PPM).
Correct Answer: B
Rationale: Time Pressure Management (TPM) is a therapeutic approach designed to help individuals with attention deficits manage their slowed information processing. Instead of focusing on improving attention directly, TPM teaches compensatory strategies, such as breaking tasks into smaller steps, prioritizing activities, and using external aids like timers or reminders. This approach helps individuals adapt to their cognitive limitations and improve their ability to complete tasks efficiently.
What nursing interventions are most critical for a client diagnosed with encephalitis?
- A. Evaluating the client's ventilation capacity and lung sounds frequently.
- B. Observing closely for signs of respiratory distress.
- C. Administering an indwelling urethral catheter.
- D. Monitoring vital signs and LOC frequently.
Correct Answer: B
Rationale: Respiratory distress is a potential complication requiring close monitoring.
A 78-year-old woman has a physiologic change related to aging in her joints. What is an appropriate nursing intervention related to common changes of aging in the musculoskeletal system?
- A. Encourage rest to eliminate fatigue
- B. Provide all care for the patient to ensure that care is completed
- C. Encourage eating enough calories to avoid the risk for impaired skin integrity
- D. Have the patient exercise to maintain muscle strength and avoid the risk for falls
Correct Answer: D
Rationale: Exercise helps maintain strength and balance.