Nokea
A mother tells the nurse her 3-year-old child has not been himself lately. The nurse examines the child. Which of the following physical findings would be cause for concern?
- A. Bruises
- B. Pale skin
- C. Enlarged lymph nodes
- D. Hives
Correct Answer: A
Rationale: Bruises, pale skin, and enlarged lymph nodes could indicate childhood cancer and need further evaluation.
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Respecting Spirituality
- A. Changing the position of the bed in a Muslim client’s room so that it faces east
- B. Contacting the chaplain to assess spiritual needs
- C. Saying a silent prayer with a client at their request
- D. Praying out loud in a dying client's room
Correct Answer: C
Rationale: Praying quietly with respect for the client's beliefs is more appropriate than imposing religious actions.
Which of the following theories is an attempt to explain families as a set of interacting individuals with patterns of living that influence health decisions?
- A. Feminist theory
- B. Systems theory
- C. Developmental theory
- D. Resiliency theory
Correct Answer: B
Rationale: Systems theory views families as interconnected individuals whose patterns of living influence health decisions.
Which of the following scenarios best describes a nurse using metacommunication?
- A. Using both touch and silence when counseling an individual
- B. Practicing reflection when interacting with an individual
- C. Discussing with an individual how to solve a problem
- D. Understanding that an individual needs a break before proceeding
Correct Answer: D
Rationale: Metacommunication is about understanding the relationship and context of the message being communicated.
A nurse is caring for a person with the nursing diagnosis of chronic sorrow related to missed opportunities. Which of the following nursing interventions would be appropriate for this person?
- A. Sharing a personal story with the person to demonstrate empathy
- B. Assuring the person that he or she will be able to cope with the illness
- C. Encouraging the person to discuss his or her fears
- D. Contacting a support group representative for the person
Correct Answer: C
Rationale: Encouraging the person to discuss their fears is an appropriate intervention for facilitating grief work.
A 30-year-old woman with a BMI of 36 is being counseled on weight reduction. In what order should interventions be discussed?
- A. 4, 3, 2, 1
- B. 4, 2, 3, 1
- C. 3, 4, 2, 1
- D. 3, 2, 1, 4
Correct Answer: A
Rationale: The nurse should start with a full assessment (lipid profile and blood pressure), followed by education on diet and exercise, then medication, and finally surgery if needed.