Nokea
In which stage do you determine if the patient has achieved the expected outcomes?
- A. Implementation
- B. Evaluation
- C. Assessment
- D. Diagnosis
Correct Answer: B
Rationale: Evaluation is the correct stage in the nursing process to determine if the patient has achieved the expected outcomes. During the evaluation stage, the healthcare provider assesses the effectiveness of the care plan and decides on any necessary adjustments to reach the desired goals.
Choice A, Implementation, is incorrect because this stage involves putting the care plan into action. Choice C, Assessment, is incorrect as it is the stage where data about the patient's health status is gathered. Choice D, Diagnosis, is also incorrect as it is the stage where the healthcare provider identifies the patient's health problems based on the assessment data.
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Based on the complaints provided by Madam KK, is the child exhibiting danger signs?
- A. Yes
- B. No
- C. I don't know
- D. Yes
Correct Answer: A
Rationale: Yes, the child is displaying danger signs with symptoms such as fever and rapid breathing, indicating a potential serious health issue that requires immediate attention. The correct answer is 'Yes' because the symptoms described in Madam KK's complaints align with danger signs that suggest a severe health problem. Choices B and C are incorrect because the symptoms mentioned clearly indicate the presence of danger signs. Choice D is a duplicate of choice A and does not provide a valid alternative.
A child is being admitted to the hospital for probable pneumonia. The nurse asks what the parents have done at home for this illness. The parent comments that they have given the child a tea made up of herbs that a neighbor recommended. The parents ask if that is a safe thing to do. The most appropriate response for the nurse is:
- A. Sure, if it doesn't make the child worse, it could help.
- B. Of course, teas are rarely harmful.
- C. It might be safe for adults, but research might not have been conducted on the effects on children.
- D. Absolutely not, herbal teas are not appropriate for children.
Correct Answer: C
Rationale: The most appropriate response is C: 'It might be safe for adults, but research might not have been conducted on the effects on children.' This response acknowledges the potential differences in the effects of herbal teas on adults versus children and highlights the importance of considering the lack of specific research on this topic when it comes to pediatric care. Choice A is incorrect because assuming something is safe without evidence can be risky in a pediatric setting. Choice B is also incorrect as it oversimplifies the safety of herbal teas. Choice D is too definitive and does not consider the possibility that herbal teas might have different effects on children than on adults.
When does the rash in typhoid fever typically appear?
- A. On the second day after symptoms appear
- B. On the third day after symptoms appear
- C. On the fourth day after symptoms appear
- D. On the seventh day after symptoms appear
Correct Answer: B
Rationale: In typhoid fever, the rash typically appears on the third day after symptoms first appear. This rash can help in diagnosing the disease along with other symptoms such as fever, malaise, and abdominal pain. Choices A, C, and D are incorrect because the rash in typhoid fever usually appears on the third day, not the second, fourth, or seventh day after the symptoms begin.
A mother of a 2-year-old child complains that her child has a fever, sore mouth, and red eye. What will be the possible diagnosis?
- A. TB
- B. Meningitis
- C. Measles
- D. Pertussis
Correct Answer: C
Rationale: The correct answer is C, Measles. Measles commonly presents with symptoms such as fever, sore mouth, and red eyes. These characteristic symptoms help differentiate measles from the other conditions listed. Tuberculosis (Choice A) typically presents with respiratory symptoms, Meningitis (Choice B) commonly presents with symptoms like headache, neck stiffness, and altered mental status, while Pertussis (Choice D) is characterized by severe coughing spells. Therefore, in this case, the symptoms described align more closely with measles.
During a well-child visit, a 10-year-old child is found to be above the 95th percentile for weight and reports watching more than two hours of television daily. An appropriate nursing diagnosis for this child is:
- A. Imbalanced Nutrition: More than body requirements
- B. Altered Growth and Development
- C. Ineffective Coping
- D. Altered Family Processes
Correct Answer: A
Rationale: The correct nursing diagnosis for a 10-year-old child who is above the 95th percentile for weight and watches more than two hours of television daily would be 'Imbalanced Nutrition: More than body requirements.' This diagnosis reflects the excessive intake of nutrients compared to the child's energy expenditure, which can contribute to weight gain. 'Altered Growth and Development' (choice B) is not the most appropriate diagnosis in this scenario, as the primary concern is related to nutrition and sedentary behavior rather than developmental issues. 'Ineffective Coping' (choice C) and 'Altered Family Processes' (choice D) are also not relevant to the child's weight status and television habits. Monitoring and addressing the child's dietary habits and sedentary behavior are essential to promote a healthier lifestyle and prevent further weight-related issues.