Nokea
The nurse is assessing a client with suspected appendicitis. Which test should the nurse perform to confirm the diagnosis?
- A. Rovsing's sign
- B. Murphy's sign
- C. Psoas sign
- D. Both A and C
Correct Answer: D
Rationale: Rovsing's sign (pain in the right lower quadrant with left-sided pressure) and psoas sign (pain with leg extension) support an appendicitis diagnosis.
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A nurse notices that a newborn has a swelling in the scrotum. The nurse should interpret this as indicative of hydrocele if which of the following occurs?
- A. The swollen bulge can be reduced.
- B. The increase in scrotal size is bilateral.
- C. The scrotal sac can be transilluminated.
- D. The bulge appears during crying.
Correct Answer: C
Rationale: Transillumination of the scrotal sac indicates fluid, characteristic of a hydrocele, a common newborn condition.
The current focus of performance improvement activities is to facilitate and address:
- A. Sound structures like policies and procedures
- B. Processes and how they are being done
- C. Optimal client outcomes
- D. Optimal staff performance
Correct Answer: C
Rationale: Performance improvement activities focus on achieving optimal client outcomes by improving the quality and safety of care delivery.
A client with a diagnosis of Parkinson's disease is prescribed ropinirole (Requip). The nurse should monitor the client for which of the following side effects?
- A. Hypertension.
- B. Drowsiness.
- C. Weight gain.
- D. Hyperglycemia.
Correct Answer: B
Rationale: Ropinirole, a dopamine agonist, commonly causes drowsiness, which the nurse should monitor in Parkinson's clients.
Which statement about targeted assessments is accurate?
- A. The need for a targeted assessment is based on the application of the nurse's knowledge of pathophysiology and the presenting symptoms.
- B. The need for a targeted assessment is based on the application of the nurse's knowledge of developmental needs and developmental delays.
- C. Targeted assessment is done on an annual basis for existing clients rather than a complete assessment that is done for new clients.
- D. Targeted assessments consist of a brief medical history and a complete assessment consists of a complete health history and a complete physical assessment.
Correct Answer: A
Rationale: Targeted assessments focus on specific health issues based on the nurse's knowledge of pathophysiology and the patient's presenting symptoms, allowing for a focused evaluation rather than a comprehensive one.
Which of the following is appropriate when developing a plan of care for promoting the development of a preschooler? Select all that apply.
- A. Providing anticipatory guidance for parents.
- B. Helping the parents understand their child's behavior.
- C. Identifying deviations from normal growth and development patterns.
- D. Determining the child's future development.
- E. Sending the child to a day care center.
Correct Answer: A,B,C
Rationale: Anticipatory guidance, understanding behavior, and identifying deviations support preschooler development. Predicting future development is not feasible, and daycare is not universally required.