Nokea
The nurse is providing care to a 75-year-old female patient diagnosed with osteoporosis. Which of the following would be the priority nursing diagnosis?
- A. At risk for falls related to impaired balance
- B. Knowledge deficit related to new medication regimen
- C. Impaired physical mobility related to pain and skeletal changes
- D. Ineffective health maintenance related to continued immobility
Correct Answer: A
Rationale: The correct answer is A: At risk for falls related to impaired balance. This is the priority nursing diagnosis because falls can lead to serious injury in elderly patients with osteoporosis. Impaired balance is a significant risk factor for falls in this population. Choice B is not the priority as safety takes precedence over knowledge deficit. Choice C may be secondary to the risk of falls. Choice D is not the priority as preventing falls and ensuring patient safety are more critical in this case.
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Which patient may require more help and understanding when integrating the newborn into the family?
- A. A primipara from an upper income family
- B. A primipara who comes from a large family
- C. A multipara (gravida 2) who has a supportive husband and mother
- D. A multipara (gravida 6) who has two children younger than 3 years
Correct Answer: D
Rationale: The correct answer is D because a multipara with six pregnancies and two young children may require more help and understanding due to the potential challenges of caring for multiple young children simultaneously. The presence of two children younger than 3 years old indicates that the mother may be experiencing higher levels of stress and demands on her time and energy. This situation could lead to difficulties in integrating the newborn into the family dynamics.
Choice A is incorrect because being from an upper-income family does not necessarily indicate a need for more help and understanding. Choice B is incorrect because coming from a large family does not directly correlate with requiring more assistance when integrating a newborn. Choice C is incorrect because having a supportive husband and mother can provide valuable assistance and may not necessarily indicate a greater need for help compared to the scenario described in choice D.
Which factor is least likely to influence the decision to undergo genetic testing?
- A. Anxiety and altered family relationships
- B. Cost of testing or denial of insurance benefits
- C. Imperfection of test results
- D. Ethnic and socioeconomic disparity associated with genetic testing
Correct Answer: B
Rationale: Testing is not 100% accurate and has a high percentage of false-negative results. An individual may not take these results seriously and subsequently fail to have testing completed or to seek necessary follow-up consultation. Anxiety and altered family relationships are often the result of genetic testing. The results of genetic testing may be difficult to keep confidential, and family members may feel pressured to have testing performeDecisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Caucasian middle-class families have greater access to genetic screening; therefore, this population is less at likely to decide against genetic testing.
Which resource best describes a health care service representing the tertiary level of prevention?
- A. Stress management seminars
- B. Childbirth education classes for single parents
- C. BSE pamphlet and teaching
- D. Premenstrual syndrome (PMS) support group
Correct Answer: D
Rationale: A PMS support group represents tertiary prevention, addressing a condition post-occurrence. Primary prevention includes stress management, childbirth education, and BSE pamphlets, which focus on health promotion and early detection.
A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. Which of the following medications should the nurse plan to administer?
- A. Digoxin
- B. Calcium gluconate
- C. Vitamin B6
- D. Propranolol
Correct Answer: C
Rationale: Vitamin B6 (pyridoxine) is used to treat nausea and vomiting in pregnancy, including hyperemesis gravidarum.
At the present time, which agency governs surrogate parenting?
- A. State law
- B. Federal law
- C. Individual court decision
- D. Protective child services
Correct Answer: A
Rationale: The correct answer is A: State law. Surrogate parenting laws are primarily regulated at the state level in the United States. Each state has its own laws and regulations regarding the legality and requirements of surrogate parenting arrangements. Federal law does not specifically govern surrogate parenting. While individual court decisions may impact specific cases, they do not set overarching regulations for surrogate parenting. Protective child services focus on the welfare and protection of children in cases of abuse or neglect, not on the legality of surrogate parenting arrangements. Thus, state law is the correct answer as it is the primary authority governing surrogate parenting.