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Sue has a mild dermatitis rash and asks for advice. You respond by saying
- A. Wash the area with an antiseptic soap frequently to keep the area clean.
- B. Use an antifungal ointment.
- C. Use talcum powder to soothe the inflamed skin.
- D. Use a mild steroidal cream.
Correct Answer: D
Rationale: Steroidal creams reduce inflammation in dermatitis.
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Tom arrives in the Emergency Room (ER) and is unable to move his legs as a result of an automobile accident that occurred 30 minutes ago. You respond by saying
- A. Swelling due to the initial trauma prevents you from moving your legs.
- B. There are good rehabilitation centers that will help restore sensation to your legs.
- C. Swelling due to the initial trauma may make the injury seem more severe than it actually is. A more accurate assessment will be made once the swelling goes down.
- D. You should have been wearing your seatbelt.
Correct Answer: C
Rationale: Initial swelling can mask the true extent of spinal injuries.
Which verbal and nonverbal communication techniques are effective with most American clients?
- A. Maintaining eye contact and using clear language.
- B. Using technical jargon and formal language.
- C. Avoiding physical proximity altogether.
- D. Speaking loudly and using gestures.
Correct Answer: A
Rationale: Maintaining eye contact and using clear, concise language aligns with cultural norms in America, enhancing communication effectiveness.
The nurse is caring for a client with cirrhosis of the liver with ascites. When instructing nursing assistants in the care of the client, the nurse should emphasize that:
- A. The client should remain on bed rest in a semi-Fowler's position.
- B. The client should alternate ambulation with bed rest with legs elevated.
- C. The client may ambulate and sit in chair as tolerated.
- D. The client may ambulate as tolerated and remain in semi-Fowlers positioning bed.
Correct Answer: D
Rationale: Semi-Fowler's position aids in breathing and reduces pressure on the abdomen.
In assigning patients with alterations related to gastrointestinal (GI) cancer, which would be the most appropriate nursing care tasks to assign to the LPN/LVN, under supervision of the team leader RN?
- A. A patient with severe anemia secondary to GI bleeding.
- B. A patient who needs enemas and antibiotics to control GI bacteria.
- C. A patient who needs pre-op teaching for bowel resection surgery.
- D. A patient who needs central line insertion for chemotherapy.
Correct Answer: B
Rationale: Administering enemas and antibiotics involves routine tasks that LPNs/LVNs are trained to perform, whereas the other options require advanced skills or supervision.
A client has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor?
- A. Confusion
- B. Weakness
- C. Increased intracranial pressure
- D. Increased urinary output
Correct Answer: B
Rationale: The correct answer is B: Weakness. Myasthenia gravis is characterized by muscle weakness due to an autoimmune attack on neuromuscular junctions. Monitoring for weakness is essential to assess disease progression and response to treatment. Confusion (A) is not a typical manifestation of myasthenia gravis. Increased intracranial pressure (C) is more commonly associated with conditions like head trauma or brain tumors. Increased urinary output (D) is not directly related to myasthenia gravis and is more indicative of conditions affecting the kidneys or fluid balance.