Nokea
Mr. Sands continues to be quiet and withdrawn several days after admission. Besides Raynaud phenomenon, he has generalized telangiectasis. He seldom initiates conversation, and although up ad lib, he rarely leaves his room. Which one of the following goals would be most important to develop in his nursing care plan?
- A. Provide for solitude and rest
- B. Protect from temperature extremes
- C. Enhance self-concept
- D. Move to a four-bed ward
Correct Answer: C
Rationale: Enhancing self-concept can improve social interaction and emotional well-being.
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To test for stereognosis you would
- A. Have the person close his or her eyes, then raise the person's arm and ask the person to describe its location.
- B. Touch the person with a tuning fork
- C. Place a coin in the person's hand and ask him or her to identify it.
- D. Touch the person with a cold object
Correct Answer: C
Rationale: Stereognosis is the ability to perceive and recognize the form of an object using touch. To test for stereognosis, place a familiar object, such as a coin, in the patient's hand and ask them to identify it with their eyes closed. This assesses the sensory cortex's ability to interpret tactile sensations.
A patient diagnosed with somatic symptom disorder says, I have pain from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much. It is important for the nurse to assess:
- A. mood.
- B. cognitive style.
- C. secondary gains.
- D. identity and memory.
Correct Answer: C
Rationale: The correct answer is C: secondary gains. In this scenario, the patient's focus on pain and dependency suggests potential secondary gains, such as attention or avoidance of responsibilities. Assessing secondary gains helps in understanding the underlying motivations for the symptoms. Mood (choice A) may be important but doesn't directly address the patient's behavior. Cognitive style (choice B) and identity/memory (choice D) are not as relevant in this context as secondary gains in somatic symptom disorder.
In caring for a client with Parkinson disease, it would be most important to
- A. encourage a low-residue diet
- B. explain the nature and treatment of the disease
- C. restrict fluid intake
- D. provide a walker for ambulation
Correct Answer: B
Rationale: Education about the disease helps patients manage their condition effectively.
Compared with myelinated nerve fibres, non-myelinated nerve fibres:
- A. have a higher threshold for stimulation
- B. have a longer refractory period
- C. transmit impulses at a lower frequency
- D. all above
Correct Answer: D
Rationale: Non-myelinated nerve fibers have a higher stimulation threshold, longer refractory period, and lower impulse transmission frequency compared to myelinated fibers. These differences are due to the lack of saltatory conduction in non-myelinated fibers.
The first stage of Alzheimer's disease is characterized by:
- A. depression and anger
- B. hand tremors and confusion
- C. headaches and depression
- D. memory loss and confusion
Correct Answer: D
Rationale: The first stage of Alzheimer's disease is typically marked by memory loss and confusion, particularly with recent events. As the disease progresses, more severe cognitive and functional impairments develop.