Nokea
The nurse is teaching the parent of an infant client about common pediatric conditions. Which statement by the nurse about otitis media is correct?
- A. Otitis media usually occurs before your child experiences a primary bacterial infection.'
- B. Some causes of otitis media can be prevented by administering a vaccine to your child.'
- C. Ear infections are very contagious and can also spread within your child's body.'
- D. If your infant uses a pacifier, it can prevent the development of otitis media.'
Correct Answer: B
Rationale: Otitis media (OM), middle ear infection, is often bacterial (e.g., Streptococcus pneumoniae). The correct statement is B: vaccines like PCV13 prevent some causes by targeting pathogens. A is false; OM typically follows infections. C is wrong; OM isn't highly contagious or systemic. D is incorrect; pacifiers increase OM risk. Rationale: Vaccines reduce OM incidence by immunizing against common bacteria, a key preventive strategy per AAP guidelines, unlike the other statements which misrepresent etiology or prevention.
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A staff nurse who is promoted to assistant nurse manager may feel uncomfortable initially when supervising her former peers. She can best decrease this discomfort by:
- A. Writing down all assignments
- B. Making changes after evaluating the situation and having discussions with the staff
- C. Telling the staff nurses that she is making changes to benefit their performance
- D. Evaluating the clinical performance of each staff nurse in a private conference
Correct Answer: B
Rationale: Evaluating and discussing changes eases transition and builds trust.
Mr. Gary underwent heart surgery in a specialized hospital. This is an example of?
- A. Primary care
- B. Secondary care
- C. Tertiary care
- D. Health promotion
Correct Answer: C
Rationale: Heart surgery in a specialized hospital is tertiary care (C) advanced, per system. Primary (A) initial, secondary (B) referral, promotion (D) preventive not surgical. C fits high-level care, making it correct.
Which of the following statement is NOT true about Hospice care?
- A. Offered to terminally ill client
- B. The client's family is included in the care
- C. Focuses on relieving symptoms
- D. Requires client to sign a DNR
Correct Answer: D
Rationale: Hospice cares for terminally ill (A), includes family (B), and relieves symptoms (C), per hospice philosophy. Requiring a DNR (D) isn't true preferred, not mandatory; care focuses on comfort, not resuscitation status. D's absolute requirement misaligns with flexibility, making it the untrue statement.
All of the following are purpose of inflammation except
- A. Increase heat, thereby produce abatement of phagocytosis
- B. Localized tissue injury by increasing capillary permeability
- C. Protect the issue from injury by producing pain
- D. Prepare for tissue repair
Correct Answer: A
Rationale: Inflammation aims to protect and heal tissue, not hinder it. Increasing heat (A) enhances phagocytosis by boosting immune cell activity, not abating it, making this statement incorrect and the exception. Localized injury response (B) occurs as capillary permeability increases, delivering immune cells to the site. Pain (C) protects by discouraging movement, aiding healing. Preparing for tissue repair (D) is a key goal as inflammation clears debris and initiates recovery. The misstatement in A reverses the biological role of heat, which supports immune function rather than suppressing it, confirming A as the answer since it does not align with inflammation's purposes.
When documenting an assigned client's record during and at the end of the shift, the nurse must keep in mind which of the following facts?
- A. In order to get the care done for all assigned clients, the charting must be as brief as possible.
- B. The proper format, such as SOAP or PIE, as chosen by the hospital, must be adhered to.
- C. The chart is a legal document and may be all a nurse has to support care that was given if called to court.
- D. Clients need to be assessed and the care documented at least once every hour during the shift.
Correct Answer: C
Rationale: Documentation is a cornerstone of nursing practice, and recognizing the chart as a legal document is paramount. It serves as the primary evidence of care provided, protecting the nurse in legal disputes by detailing actions, observations, and client responses. If called to court, this record may be the only defense against claims of negligence or improper care, making accuracy and completeness essential. Brevity might compromise detail, undermining its legal value, while specific formats like SOAP enhance clarity but aren't the core issue. Hourly documentation isn't universally required unless specified by policy; the focus is on capturing significant events. This understanding ensures nurses document with precision, safeguarding both client care and professional accountability in a legal context.