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The nurse is conducting a suicide awareness session for adults in the community. What information should the nurse include in the session?
- A. Severe life stresses at any age can increase the risk of suicide.
- B. Suicides predominantly occur in lower socioeconomic groups.
- C. Robust social support systems can prevent suicide.
- D. Discussing suicide with individuals suffering from depression can be hazardous.
Correct Answer: A
Rationale: Severe life stresses at any age can indeed increase the risk of suicide. Stressful life events can overwhelm an individual's coping mechanisms and lead to feelings of hopelessness and despair, which are significant risk factors for suicide.
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During a two-week postoperative follow-up home visit, a client who had gastric bypass surgery exhibits abdominal tenderness, shoulder pain, and feelings of malaise. The client's vital signs are an oral temperature of 101.80F (38.8° C), a blood pressure of 100/50 mm Hg, a heart rate of 104 beats/minute, and a respiratory rate of 18 breaths/minute. What is the appropriate action for the nurse to take?
- A. Recheck the client's vital signs in 30 minutes.
- B. Have the client transported via ambulance to the hospital.
- C. Determine the client's current oxygen saturation rate.
- D. Instruct the client to drive to the hospital for admission.
Correct Answer: B
Rationale: Having the client transported via ambulance to the hospital is the most appropriate action. The client's symptoms suggest possible complications that require immediate medical attention. Abdominal tenderness and shoulder pain could indicate a serious condition such as a perforation or infection.
The nurse is collaborating with a Parent-Teacher Organization (PTO) to enhance safety for children walking to and from a nearby elementary school. Which action should the nurse include to achieve this goal?
- A. Assist the residents in planning a campaign to remind drivers passing through the school zone to always wear seatbelts.
- B. Advise the residents to keep their porch lights on during the hours when children are walking to and from school.
- C. Encourage residents with older homes along the school route to have their homes inspected for high lead levels.
- D. Facilitate a discussion about the advantages of having designated safe houses located throughout the school neighborhood.
Correct Answer: D
Rationale: Facilitating a discussion about the advantages of having designated safe houses located throughout the school neighborhood can significantly enhance the safety of children walking to and from school. Safe houses can provide a secure place for children to go if they feel threatened or in danger while walking to or from school.
A 42-year-old male client, who started experiencing mild flu-like symptoms 2 days ago, including an oral temperature of 101.2 °F (38.4 °C), came to the emergency department today due to increasing shortness of breath, cough, and chest pain. The client has no significant medical or surgical history. He occasionally drinks alcohol but denies smoking or drug use. He mentioned that he works in a government building and opened a package that was full of white powder. He may have inhaled some of the powder and coughed a few times but did not have any problems until a couple of days later. What actions should be taken?
- A. Apply oxygen via a nasal cannula.
- B. Place the client on a cardiorespiratory monitor.
- C. Infuse IV fluid boluses.
- D. Administer antiviral medication.
Correct Answer: B
Rationale: Given the client's symptoms and potential exposure to an unknown substance, it is crucial to monitor his vital signs and cardiorespiratory status. This will help healthcare providers detect any changes in the client's condition and respond appropriately.
A 5-year-old patient has been brought in for a routine check-up and vaccination update. The mother reports that the child has been having difficulty focusing in school and has shown a decreased appetite in recent weeks. What actions should the nurse take?
- A. Review the child's medical history for any allergies or sensitivities.
- B. Examine the child's torso and arms for any signs of physical trauma.
- C. Advise the parents to initiate treatment with permethrin.
- D. Recommend the parents to seek further medical evaluation for the child.
Correct Answer: D
Rationale: Given the child's symptoms of difficulty focusing in school and decreased appetite, it would be appropriate to recommend the parents to seek further medical evaluation for the child. These symptoms could be indicative of various conditions, including emotional distress, sleep disorders, or other health issues.
The home health nurse visits a young adult client who has AIDS with Kaposi's sarcoma and peripheral neuropathies. The client's parents, who are the caretakers, tell the nurse that their child sleeps most of the time. The nurse assesses that the client is semi-conscious with stable vital signs, cries out in pain when turned or moved, has a fentanyl patch in place, and skin lesions that are closed and dried. Which intervention should the nurse implement?
- A. Give a complete bed bath to further assess the client.
- B. Remove the fentanyl patch as directed by prescription.
- C. Call for ambulance transportation to the hospital immediately.
- D. Discuss end-of-life decisions with the client's parents.
Correct Answer: D
Rationale: Discussing end-of-life decisions with the client's parents is the most appropriate intervention. The client is semi-conscious, sleeps most of the time, and is in significant pain. These symptoms suggest that the client's condition is deteriorating. It is important to have conversations about end-of-life care preferences and decisions to ensure that the client's wishes are respected and that the parents are prepared.