Nokea
The nurse is preparing to take vital signs in an alert client admitted with dehydration secondary to vomiting and diarrhea. What is the best method to assess the client's temperature?
- A. Oral
- B. Axillary
- C. Radial
- D. Heat sensitive tape
Correct Answer: B
Rationale: Axillary is safest and most accessible for a dehydrated client with GI issues, avoiding oral route due to vomiting and diarrhea.
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After a day, Mr Gary's wife shouted at the nurse and said 'You're not doing your job right! My husband is dying because of you!' This is an example of?
- A. Denial
- B. Anger
- C. Bargaining
- D. Depression
Correct Answer: B
Rationale: Shouting 'You're not doing your job is anger (B), per Kubler-Ross lashing out in grief. Denial (A) rejects, bargaining (C) pleads, depression (D) withdraws. Anger targets others, fitting her outburst, making it correct.
When recording blood pressure, the sounds which can be heard with a stethoscope placed over the artery is termed as:
- A. Wheeze
- B. Murmurs
- C. Crackle sounds
- D. Korotkoff sounds
Correct Answer: D
Rationale: Blood pressure measurement involves listening to arterial sounds via a stethoscope as the cuff deflates. These sounds, known as Korotkoff sounds, occur in five phases, starting with a tapping (systolic pressure) and fading to silence (diastolic pressure). Wheezes are respiratory sounds, murmurs relate to heart valves, and crackles indicate lung fluid none apply to blood pressure. Named after Nikolai Korotkoff, these sounds are a cornerstone of manual blood pressure assessment, ensuring accurate readings essential for diagnosing hypertension or hypotension, reflecting cardiovascular health.
When a client wishes to improve the appearance of their eyes by removing excess skin from the face and neck, the nurse should provide teaching regarding which of the following procedures?
- A. Dermabrasion
- B. Rhinoplasty
- C. Blepharoplasty
- D. Rhytidectomy
Correct Answer: D
Rationale: Rhytidectomy (facelift) removes excess skin from face and neck.
A nurse identifies ways he/she can improve performance. He/she reflects on his nursing experiences. This is an example of the core critical thinking skill:
- A. Self-regulation
- B. Analysis
- C. Inference
- D. Explanation
Correct Answer: A
Rationale: Self-regulation in critical thinking involves monitoring and improving one's performance through reflection on experiences, identifying strengths and weaknesses. A nurse reflecting on past care to enhance future practice exemplifies this e.g., adjusting communication after a patient misunderstanding. Analysis breaks down data (e.g., lab results), not necessarily reflecting on personal performance. Inference draws conclusions from evidence (e.g., diagnosing from symptoms), not self-improvement. Explanation justifies actions (e.g., why a drug was given), not introspective growth. Self-regulation's focus on self-assessment and correction aligns with the nurse's reflective process, fostering continuous professional development, a vital skill in nursing for adapting to challenges and ensuring high-quality, patient-centered care over time.
As a nurse manager, which of the following best describes this function?
- A. Initiate modification on client's lifestyle
- B. Protect client's right
- C. Coordinates the activities of other members of the health team in managing patient care
- D. Provide in service education programs, Use accurate nursing audit, formulate philosophy and vision of the institution
Correct Answer: D
Rationale: A nurse manager's role encompasses planning (vision formulation), organizing (team coordination), directing (training), and controlling (audits), per management theories like Venzon's. This holistic function e.g., setting care standards, training staff, evaluating outcomes ensures quality across a unit, unlike narrower roles like lifestyle change (change agent), rights protection (advocate), or team coordination (case manager). It's a strategic position driving institutional excellence, pivotal in healthcare leadership.