Nokea
The nurse is planning an immunization campaign targeting the children of migrant farm workers in the community. Which data should the nurse review before exploring solution options when developing this program plan?
- A. uncertain risks
- B. potential outcomes
- C. priority of solutions
- D. target population data -
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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During a home visit, the nurse observes that a client with limited mobility has difficulty accessing the bathroom. What should the nurse do first?
- A. suggest the client installs a bedside commode
- B. assist the client in modifying the home environment
- C. refer the client to an occupational therapist
- D. educate the client on mobility aids
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is caring for a client with Addison's disease. Which finding requires immediate intervention?
- A. Hyperpigmentation of the skin.
- B. Low blood pressure.
- C. Nausea and vomiting.
- D. Hypoglycemia.
Correct Answer: B
Rationale: Low blood pressure in a client with Addison's disease requires immediate intervention as it can indicate an Addisonian crisis, a life-threatening condition that necessitates prompt treatment. Hyperpigmentation of the skin is a characteristic finding in Addison's disease but does not require immediate intervention. Nausea and vomiting can be managed symptomatically in Addison's disease. While hypoglycemia needs attention, it is not the most critical finding requiring immediate intervention in this context.
Following an emergency Cesarean delivery, the nurse encourages the new mother to breastfeed her newborn. The client asks why she should breastfeed now. Which information should the nurse provide?
- A. To bond with the baby.
- B. To help the baby latch on better.
- C. To stimulate contraction of the uterus.
- D. To promote milk production.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with type 2 diabetes mellitus is admitted with hyperosmolar hyperglycemic state (HHS). Which laboratory result requires immediate intervention?
- A. Serum osmolality of 320 mOsm/kg.
- B. Serum glucose of 600 mg/dL.
- C. Serum potassium of 4.5 mEq/L.
- D. Serum sodium of 140 mEq/L.
Correct Answer: B
Rationale: A serum glucose level of 600 mg/dL is extremely high in a client with hyperosmolar hyperglycemic state (HHS) and poses a significant risk of serious complications such as dehydration, coma, and electrolyte imbalances. Rapid intervention is crucial to normalize the glucose level and prevent further deterioration. Serum osmolality of 320 mOsm/kg, serum potassium of 4.5 mEq/L, and serum sodium of 140 mEq/L, while important to monitor in HHS, do not represent an immediate life-threatening condition that requires urgent intervention compared to the critically high glucose level.
An older female client tells the home health nurse that she has no money, and since she does not deserve to eat, she has not asked anyone to bring her food. What information is most important for a nurse to obtain?
- A. client's thoughts about wanting to hurt herself
- B. medication history for antipsychotic agents
- C. availability of family members to provide meals
- D. community resources to provide financial aid
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.