Nokea
A group of senior citizens.
The nurse teaches a health class at the local library to a group of senior citizens. Which of the following behaviors should the nurse emphasize to facilitate regular bowel elimination?
- A. Avoid strenuous activity.
- B. Eat more foods with increased bulk.
- C. Decrease fluid intake to decrease urinary losses.
- D. Use oral laxatives so that a bowel pattern emerges.
Correct Answer: B
Rationale: Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) regular exercise program facilitates bowel elimination (2) correct-contained in whole grains, legumes, vegetables, fruits, seeds, nuts, bulk promotes peristalsis (3) normal fluid intake of 1,500 cc/day facilitates bowel elimination (4) laxatives used as last resort because they become habit-forming
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The nurse is supervising a student nurse teach a client about a newly prescribed medication. Which of the following actions, if observed by the nurse, would require an intervention?
- A. The student nurse glances at his/her watch when instructing the client.
- B. The student nurse uses culturally appropriate language and teaching materials.
- C. The student nurse begins instructions to the client discussing information that concerns the client.
- D. The student nurse chooses a time for teaching when there are no visitors.
Correct Answer: A
Rationale: lack of attending behaviors are always a barrier to learning
The nurse is caring for a 33-year-old woman after delivering an 8 lb 4 oz girl with talipes equinovarus. The woman confides to the nurse, 'I feel so bad that my baby is abnormal.' Which of the following responses by the nurse is BEST?
- A. It's understandable that you feel this way, but there are treatments to correct your baby's problem.
- B. Your baby is not really abnormal. Her feet just look different because of the way the muscles pull.
- C. You have nothing to feel guilty about. The abnormality is not your fault.
- D. Don't feel bad. You baby's abnormality can be corrected surgically.
Correct Answer: A
Rationale: accepts feelings and gives correct information, serial casting is used
A middle-aged adult is seen in the emergency room for complaints of severe right-flank pain. The client is twenty pounds overweight, lives a sedentary lifestyle, and was treated for renal calculi four years ago. Which of the following actions, if performed by the nurse, is MOST important?
- A. Ensure that the client has nothing to eat or drink.
- B. Obtain a 'clean-catch' urine specimen for analysis.
- C. Provide warm packs to relieve discomfort.
- D. Measure and strain the client's urine.
Correct Answer: D
Rationale: will document passage of stone and allow composition to be analyzed
A 36-year-old client tested positive for the tuberculosis antibody and was placed on isoniazid (INH) four weeks ago. The nurse would be MOST concerned if which of the following was observed?
- A. Fatigue and dark urine.
- B. Malaise and glucosuria.
- C. Proteinuria and lethargy.
- D. Diluted urine and epigastric distress.
Correct Answer: A
Rationale: initial indications of hepatic dysfunction
Which of the following guidelines is appropriate for the nurse to give a mother concerning the developmental stage of her seven-year-old daughter?
- A. The child's periods of shyness are to be expected.
- B. Nightmares are not characteristic of this age and should be investigated.
- C. The child should be encouraged to care for her younger sister.
- D. Punishment may be necessary for acts of independence.
Correct Answer: A
Rationale: normal for developmental stage, beginning to show independence from parents