Nokea
The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
- A. Visual disturbances, including diplopia
- B. Ascending paralysis and loss of motor function
- C. Cogwheel rigidity and loss of coordination
- D. Progressive weakness that is worse at the day's end
Correct Answer: D
Rationale: Progressive weakness worse at day's end (fatigue) is classic in myasthenia gravis, due to acetylcholine receptor issues diplopia occurs but isn't primary, ascending paralysis fits Guillain-Barré, and rigidity is Parkinson's. Nurses assess this, aiding diagnosis, key for neuromuscular care.
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Client has undergone Upper GI and Lower GI series. Which type of health assessment framework is used in this situation?
- A. Functional health framework
- B. Head to toe framework
- C. Body system framework
- D. Cephalocaudal framework
Correct Answer: C
Rationale: Upper and Lower GI series use a body system framework (C), targeting digestive system, per assessment types. Functional (A) assesses ADLs, head-to-toe (B) and cephalocaudal (D) are physical sweeps. C fits organ focus, making it correct.
What equipment would be necessary to complete an evaluation of cranial nerves 9 and 10 during a physical assessment?
- A. A cotton ball
- B. A penlight
- C. An ophthalmoscope
- D. A tongue depressor and flashlight
Correct Answer: D
Rationale: Cranial nerves 9 and 10 (glossopharyngeal and vagus) are assessed with a gag reflex, requiring a tongue depressor and light.
The nurse and doctor jointly planned Mr. Gary's treatment. This is an example of?
- A. Collaboration
- B. Professionalism
- C. Health literacy
- D. Care transition
Correct Answer: A
Rationale: Joint planning with doctor is collaboration (A) working together, per definition. Professionalism (B) standards, literacy (C) understanding, transition (D) moves not joint-specific. A fits teamwork, making it correct.
Which of the following statement is TRUE about palliative care?
- A. Palliative care is given only on Hospice setting
- B. Palliative care is given only to cancer clients
- C. Palliative care improves quality of life
- D. Palliative care is offered only when the client's condition is irreversible
Correct Answer: C
Rationale: Palliative care improves quality of life (C), per its goal managing symptoms, enhancing comfort. It's not hospice-only (A), not cancer-specific (B), and applies beyond irreversible states (D) available at any serious illness stage. C's universal truth aligns with palliative principles, making it correct.
Which of the following statement is TRUE about assault?
- A. Touching the client without consent
- B. An intentional threat
- C. Causes physical harm
- D. All of the above
Correct Answer: B
Rationale: Assault is an intentional threat (B), per law e.g., menacing gesture, no contact needed. Touching (A) is battery, harm (C) not required, all (D) oversteps. B truly defines assault's intent, making it correct.