Nokea
The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is:
- A. The individual will experience no anxiety.
- B. The individual will demonstrate hope for the future.
- C. The individual will maintain anxiety at manageable level.
- D. The individual will verbalize acceptance of self as worthy.
Correct Answer: C
Rationale: The correct answer is C because it focuses on managing the anxiety at a manageable level, which is a realistic and achievable goal in the short term. This approach acknowledges the individual's current state and aims to provide coping strategies to help them function despite the anxiety. Option A is incorrect as it is unrealistic to expect no anxiety after a traumatic event. Option B is not the immediate priority when the individual is experiencing panic anxiety. Option D is also incorrect as self-acceptance may be a long-term goal but is not the immediate focus in managing panic anxiety.
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How many mLs will you administer to the client after you use 3.3 mL of normal saline to reconstitute a medication that will yield 12 mg per mL and the doctor's order is as follows. Doctor's order: 25 mg of medication BID
- A. 1.9 mL
- B. 2.0 mL
- C. 2.5 mL
- D. 2.1 mL
Correct Answer: D
Rationale: 25 mg / 12 mg/mL = 2.083 mL, rounded to 2.1 mL (D) per dose.
A patient admitted yesterday for injuries sustained in a fall while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?
- A. Ineffective airway clearance
- B. Ineffective coping
- C. Ineffective denial
- D. Risk for injury
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. This is the priority nursing diagnosis because the patient's current state of agitation and anxiety, coupled with the belief of bugs crawling on the bed, poses an immediate risk for self-injury. The patient's altered mental status and intoxication increase the likelihood of accidental harm.
Explanation for other choices:
A: Ineffective airway clearance - While this is always a critical concern, the patient's current presentation does not indicate any immediate threat to the airway.
B: Ineffective coping - While the patient may be experiencing distress, the primary focus should be on addressing the risk of injury given the patient's altered mental status.
C: Ineffective denial - While the patient may be experiencing hallucinations, the primary concern is the risk of injury rather than the patient's denial of the situation.
Jack and Ann have come to the clinic for family therapy. They have been married for 18 years. Jack had an affair with his secretary 5 years ago. He fired the secretary and assures Ann and the nurse that he has been faithful ever since. Jack tells the nurse, 'We have never been able to get along with each other. We can’t talk about anything . . . all we do is shout at each other. And every time she gets angry with me, she brings up my infidelity. I can’t even imagine how many times each of us has threatened divorce over the years. Our kids don’t have any idea what it is like to have parents who get along with each other. I’ve really had enough!' The nurse would most likely document which of the following in her assessment of this couple?
- A. Marital skew
- B. Pseudohostility
- C. Double-bind communication
- D. Marital schism
Correct Answer: D
Rationale: The correct answer is D: Marital schism. Marital schism refers to a state of constant conflict and disengagement in a marriage. In this scenario, Jack and Ann exhibit a significant disconnect in their relationship, as evidenced by their inability to communicate effectively, frequent shouting matches, and unresolved issues such as Jack's infidelity. The nurse would likely document a marital schism in her assessment due to the ongoing discord and lack of emotional connection between the couple.
Incorrect choices:
A: Marital skew typically refers to power imbalances in a relationship, which is not the primary issue in this case.
B: Pseudohostility involves false or exaggerated hostility, which is not the main concern in Jack and Ann's situation.
C: Double-bind communication involves contradictory messages leading to confusion, which is not the central issue in this scenario.
Girls mature than boys.
- A. Slower
- B. Faster
- C. Both of these
- D. None of these
Correct Answer: B
Rationale: Girls typically reach physical and cognitive maturity faster than boys, especially in early development.
he theorist who believes that human have autonomy is
- A. Sigmund Freud
- B. Carl Rogers
- C. B.F. Skinner
- D. Albert Bandura
Correct Answer: B
Rationale: Carl Rogers' humanistic theory emphasizes autonomy and self-direction.