Nokea
The client diagnosed with HIV is taught by the nurse that the condition is transmitted through
- A. the infection passed from a mother to her baby
- B. Tears
- C. human bites
- D. insect bites
Correct Answer: A
Rationale: HIV can be transmitted from a mother to her baby during childbirth or breastfeeding, making choice A the correct answer. Tears, human bites, and insect bites are not common modes of HIV transmission. While human bites can potentially transmit the virus, it is less common compared to mother-to-child transmission.
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What is the most effective method to prevent medication errors during administration?
- A. Relying on memory for medication dosages
- B. Using a bar-code medication administration system
- C. Administering medications as quickly as possible to avoid delays
- D. Allowing another individual to administer medications
Correct Answer: B
Rationale: Using a bar-code medication administration system is the best method to prevent medication errors during administration. This system verifies medication details electronically, ensuring that the correct medication is given to the right patient. Relying on memory for medication dosages (choice A) is not recommended as it can lead to errors. Administering medications quickly (choice C) may increase the risk of mistakes due to haste. Allowing another individual (choice D) to administer medications does not address the root cause of preventing errors during administration.
Which task could the PN safely delegate to the UAP?
- A. Oral feeding of a two-year-old child after application of a hip spica cast
- B. Assessment of the placement and patency of a NG tube
- C. Participation in staff rounds to record notes regarding client goals
- D. Evaluation of a client's incisional pain following narcotic administration
Correct Answer: A
Rationale: The correct answer is A because oral feeding of a child is a task that can be safely delegated to an unlicensed assistive personnel (UAP). This task involves providing basic care and does not require specialized nursing skills. Choices B, C, and D involve assessments, recording client goals, and evaluating pain, respectively, which all require specialized nursing knowledge, judgment, and skills. These tasks are not within the scope of practice for a UAP.
During an inspection of a client's fingernails, the nurse notices a suspected abnormality in the shape and character of the nails. Which finding should the nurse document?
- A. Clubbed nails
- B. Splinter hemorrhages
- C. Longitudinal ridges
- D. Koilonychia or spoon nails
Correct Answer: A
Rationale: Clubbed nails are a significant finding in clients with chronic hypoxia or lung disease. This abnormality is characterized by an increased curvature of the nails and softening of the nail bed. It can indicate underlying health conditions such as respiratory or cardiovascular issues. Splinter hemorrhages (B) are small areas of bleeding under the nails, typically associated with infective endocarditis. Longitudinal ridges (C) are often a normal age-related change in the nails. Koilonychia or spoon nails (D) present as a concave shape of the nails and are commonly seen in clients with iron deficiency anemia or hemochromatosis. Therefore, documenting clubbed nails is the most relevant abnormality to report and investigate further.
When administering an analgesic to a client with low back pain, which intervention should the practical nurse implement to promote the effectiveness of the medication?
- A. Massage the lower back and position the client in proper alignment
- B. Encourage the client to ambulate frequently and take deep breaths
- C. Assist the client in performing passive and active range of motion exercises
- D. Give medication with a full glass of water and offer high-fiber foods
Correct Answer: A
Rationale: Massaging the lower back and positioning the client in proper alignment can help relieve muscle tension and enhance the effectiveness of analgesics by providing additional comfort and promoting better pain management. This intervention directly addresses the site of pain and can improve the medication's efficacy. Choices B, C, and D are incorrect because while they may have benefits in other situations, they are not directly related to promoting the effectiveness of analgesics in clients with low back pain. Encouraging ambulation and deep breathing, assisting with range of motion exercises, and offering water and high-fiber foods are important for overall patient care but are not specific to enhancing analgesic effectiveness in this context.
Which disorder is characterized by demyelination of neurons in the central nervous system?
- A. Multiple sclerosis
- B. Parkinson's disease
- C. Alzheimer's disease
- D. Huntington's disease
Correct Answer: A
Rationale: Multiple sclerosis is the correct answer. It is an autoimmune disease that specifically targets and damages the myelin sheath surrounding neurons in the central nervous system. This demyelination disrupts the transmission of nerve signals and leads to a variety of neurological symptoms. Parkinson's disease (Choice B), Alzheimer's disease (Choice C), and Huntington's disease (Choice D) are neurodegenerative disorders that do not primarily involve demyelination of neurons in the CNS. Parkinson's disease is characterized by the loss of dopamine-producing neurons, Alzheimer's disease by the formation of plaques and tangles in the brain, and Huntington's disease by a genetic mutation affecting nerve cells.