The nurse needs to assess the use of complementary and alternative medicine (CAM) because:
- A. Patients should be warned that most CAM therapies are potentially dangerous
- B. Additional treatment may not be needed if the patient is using CAM
- C. CAM therapy could interact with prescription and over-the-counter medications
- D. Most CAM therapies are essentially ineffective
Correct Answer: C
Rationale: CAM therapies can interact with medications, affecting efficacy or safety. Not all CAM is dangerous, ineffective, or a replacement for conventional treatment.
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The nurse works on a medical-surgical unit and is responsible for assessing the client's vital signs. Which of the following clients can have their temperature measured orally? Select all that apply.
- A. A 61-year-old woman who had oral surgery
- B. A 44-year old man with chest pain on oxygen via nasal canula
- C. An 83-year-old woman with diarrhea
- D. A 29-year-old client with an earache
- E. A 6-year-old client with a sore throat and difficulty swallowing
Correct Answer: B,C,D
Rationale: Oral temperature is safe for clients with chest pain, diarrhea, or earache, as they have no oral contraindications. Oral surgery and difficulty swallowing contraindicate oral measurement.
The nurse is reviewing medical-surgical concepts with a group of nursing students. When discussing pain, it is appropriate for the nurse to categorize pain that occurs with short duration as
- A. Chronic pain
- B. Acute pain.
- C. Referred pain.
- D. Neuropathic pain.
Correct Answer: B
Rationale: Acute pain is short-duration, typically linked to injury or surgery. Chronic pain is persistent, referred pain is felt elsewhere, and neuropathic pain involves nerve damage.
The emergency department charge nurse was notified of a mass shooting at a nearby shopping mall. The nurse should take which action to prepare for the surge in clients? Select all that apply.
- A. Work to arrange timely discharge and admission for appropriate clients.
- B. Establish a holding area for discharged clients not able to go home.
- C. Modify the nurse/client ratio to accommodate the surge levels.
- D. Instruct staff to switch from electronic to paper documentation.
- E. Prepare to provide frequent updates to local media.
Correct Answer: A,B
Rationale: Timely discharges/admissions and a holding area optimize resources. Modifying nurse ratios, switching to paper documentation, or media updates are not primary actions.
The nurse recognizes which of the following is considered an external disaster?
- A. Computer system failure
- B. A walkout and strike by nursing staff
- C. Mass shooting at a nearby park
- D. Chemical leak in the critical care units
Correct Answer: C
Rationale: A mass shooting at a nearby park is an external disaster, as it occurs outside the facility and impacts hospital operations. The others are internal disasters.
The nurse has attended a continuing education conference about infection control precautions. It would indicate a correct understanding of the education if the nurse is observed?
- A. using dedicated client-care equipment for a client with Clostridium difficile.
- B. wearing a particulate respirator mask (N95) while caring for a client with epiglottitis, due to Haemophilus influenzae type b.
- C. placing a surgical mask on a client being transported with radiology who has infectious mononucleosis.
- D. keeping the door closed for a client with cryptococcal meningitis.
Correct Answer: A
Rationale: Dedicated equipment for C. difficile prevents transmission. N95 is not needed for epiglottitis, masks are not required for mononucleosis transport, and cryptococcal meningitis does not require a closed door.
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