Nokea
Palpating the midclavicular line is the correct technique for assessing
- A. Baseline vital signs
- B. Systolic blood pressure
- C. Respiratory rate
- D. Apical pulse
Correct Answer: D
Rationale: Palpating the midclavicular line is the correct technique for assessing the apical pulse. The apical pulse is located at the point of maximal impulse (PMI), which is typically at the fifth intercostal space at the midclavicular line. This technique allows healthcare providers to accurately assess the heart rate and rhythm by listening to the heart sounds directly at this point.
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Which action would break sterile technique while preparing a sterile field for a dressing change?
- A. Using sterile forceps instead of sterile gloves to handle a sterile item
- B. Touching the outside wrapper of sterilized material without sterile gloves
- C. Placing a sterile object at the edge of the sterile field
- D. Pouring out a small amount of solution (15 to 30 ml) before pouring it into a sterile container
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A 38-year-old patient's vital signs at 8 a.m. are axillary temperature 99.6°F (37.6°C); pulse rate 88; respiratory rate 30. Which findings should be reported?
- A. Respiratory rate only
- B. Temperature only
- C. Pulse rate and temperature
- D. Temperature and respiratory rate
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The correct method for determining the vastus lateralis site for I.M. injection is to:
- A. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
- B. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
- C. Palpate a 1" circular area anterior to the umbilicus
- D. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The physician orders 10 gr of aspirin for a patient. The equivalent dose in milligrams is:
- A. 0.6 mg
- B. 10 mg
- C. 60 mg
- D. 600 mg
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which of the following principles of primary nursing has proven most satisfying to the patient and nurse?
- A. Continuity of patient care promotes efficient and cost-effective nursing care.
- B. Autonomy and authority for planning are best delegated to a nurse who knows the patient well.
- C. Accountability is clearest when one nurse is responsible for the overall plan and its implementation.
- D. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.
Correct Answer: D
Rationale: The holistic approach, encompassing a therapeutic relationship, continuity, and efficient nursing care, is the most satisfying principle of primary nursing. This approach considers the patient as a whole, taking into account physical, emotional, social, and spiritual aspects, which enhances the nurse-patient relationship and promotes comprehensive care. It emphasizes individualized care delivery, continuity of care, and an integrated approach, leading to improved patient satisfaction and nurse fulfillment.