Nokea
The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?
- A. Apical
- B. Radial
- C. Pedal
- D. Femoral
Correct Answer: C
Rationale: Pedal pulse absence is normal in 10-20% of people and less critical initially.
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Which of the following statement is NOT true about wellness?
- A. A dynamic process
- B. Focuses on optimal function
- C. Same with health
- D. Requires balance
Correct Answer: C
Rationale: Wellness is dynamic (A), optimal function-focused (B), balanced (D) not same as health (C), per theory. Wellness is proactive, health a state. C's identity is untrue, making it the correct false statement.
The nurse touched Mr. Gary without consent during care. This is an example of?
- A. Battery
- B. Assault
- C. Justice
- D. Nonmaleficence
Correct Answer: A
Rationale: Touching without consent is battery (A) unconsented contact, per law. Assault (B) threat, justice (C) fairness, nonmaleficence (D) harm avoidance not contact-specific. A fits the nurse's breach of Mr. Gary's autonomy, making it correct.
The nurse is caring for a client with a suspected myocardial infarction. Which laboratory value is most specific for confirming the diagnosis?
- A. Troponin I
- B. Creatine kinase (CK)
- C. Myoglobin
- D. Lactic dehydrogenase (LDH)
Correct Answer: A
Rationale: Troponin I is the most specific marker for myocardial infarction, rising within hours and staying elevated for days CK and myoglobin are less specific, LDH is outdated. Nurses monitor this, correlating with ECG and symptoms, aiding rapid diagnosis and treatment.
Mr. Gary was referred to a cardiologist for his heart condition. This is an example of?
- A. Primary care
- B. Secondary care
- C. Tertiary care
- D. Health promotion
Correct Answer: B
Rationale: Referral to a cardiologist is secondary care (B) specialized, per system. Primary (A) is initial, tertiary (C) advanced/rehab, promotion (D) preventive not specialist-based. B fits referral level, making it correct.
An infant is born precipitously outside the labor room. What should the nurse do first?
- A. Tie and cut the umbilical cord
- B. Establish an airway for the newborn
- C. Ascertain the condition of the uterine fundus
- D. Arrange transport for the mother and infant to the birthing unit
Correct Answer: B
Rationale: Precipitous birth outside controlled settings demands urgent action. Tying/cutting the cord (choice A) is secondary; delay poses no immediate risk unless bleeding occurs. Establishing an airway (choice B) is first, as newborns must breathe independently clearing mucus or stimulating crying ensures oxygenation, critical within the golden minute. Checking the fundus (choice C) assesses maternal bleeding, a later priority. Transport (choice D) follows stabilization. B is correct, per neonatal resuscitation guidelines. Nurses clear airways, warm the infant, and then address cord and maternal needs, ensuring survival.