Nokea
The nurse must verify the client's identity before administration of medication. Which of the following is the safest way to identify the client?
- A. Ask the client his name
- B. Check the client's identification band
- C. State the client's name aloud and have the client repeat it
- D. Check the room number
Correct Answer: B
Rationale: The ID band is the most reliable method, ensuring accuracy even if the client is confused.
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Considered as the most accessible and convenient method for temperature taking
- A. Oral
- B. Rectal
- C. Tympanic
- D. Axillary
Correct Answer: A
Rationale: Oral temp is most accessible e.g., quick tongue placement needing minimal prep, unlike rectal (invasive), tympanic (equipment), or axillary (longer). Convenient for alert patients, nurses favor it e.g., clinics for routine ease, per practice standards.
Which of the following statement best describes blood pressure?
- A. It is the force exerted by the blood against the walls of the blood vessels
- B. The lowest pressure is called systolic pressure
- C. BP is controlled by the sympathetic nervous system alone
- D. BP is measured using sphygmomanometer on the forearm
Correct Answer: A
Rationale: Blood pressure is the force of blood against vessel walls (A), per its definition in physiology. Systolic is the highest pressure (B), not lowest false. BP involves sympathetic and parasympathetic systems (C), not just one. Sphygmomanometers measure at the upper arm, not forearm (D). A accurately captures BP's essence, validated by clinical practice, making it the best and correct description.
The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:
- A. Instructing the patient about this diagnostic test
- B. Writing the order for this test
- C. Giving the patient breakfast
- D. All of the above
Correct Answer: C
Rationale: The nurse ensures the patient eats, while the physician handles test orders and instructions.
The nurse assesses a client at 40 weeks gestation and notes regular contractions and cervical dilatation of $6 \mathrm{~cm}$. Which actions by the nurse are important during this stage? Select all that apply.
- A. Administering the epidural injection
- B. Ensuring adequate hydration
- C. Encouraging the client to void
- D. Monitoring the condition of the fetus
Correct Answer: D
Rationale: At 40 weeks gestation with 6 cm cervical dilatation, the client is in active labor. Monitoring the fetus (D) is critical to assess for distress via heart rate patterns, a priority in labor management. Administering an epidural (A) requires an order and isn't universally needed. Ensuring hydration (B) supports labor but isn't the top action. Encouraging voiding (C) prevents bladder distension but is secondary. D is chosen. Rationale: Fetal monitoring detects hypoxia or distress, guiding interventions like position changes or delivery, per ACOG standards, outweighing comfort or supportive measures in immediacy during active labor.
One of the expectations is for nurses to join professional association primarily because of
- A. Promotes advancement and professional growth among its members
- B. Works for raising funds for nurse's benefit
- C. Facilitate and establishes acquaintances
- D. Assist them and securing jobs abroad
Correct Answer: A
Rationale: Professional associations, like the PNA, promote growth e.g., offering training, certifications enhancing skills and standards. Fundraising, networking, or job placement are secondary. This advancement focus, rooted in nursing's professionalization, ensures competence and leadership, critical for career development and patient care quality.