Nokea
The school nurse is conducting health screenings on schoolchildren. During the screening, she identifies a child with the behavioral characteristics of attention deficit disorder. Which of the following behaviors is consistent with this disorder?
- A. slow speech development
- B. overreaction to stimuli from the surroundings
- C. inability to carry on a conversation
- D. concrete thinking
Correct Answer: B
Rationale: The correct answer is 'overreaction to stimuli from the surroundings.' Children with attention deficit disorder often exhibit hypersensitivity to stimuli, leading to overreactions. Slow speech development is not a hallmark of attention deficit disorder; it is more associated with other learning disabilities. While children with this disorder may have difficulty focusing, they can usually carry on a conversation. Concrete thinking is not a common characteristic of attention deficit disorder, as individuals with this disorder may struggle with abstract thinking and impulsivity.
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The LPN needs to determine the client's respiratory rate. What is the best technique to do this?
- A. Tell the client you need to count their respiratory rate.
- B. Subtly watch the client from across the room when they are doing an activity.
- C. Ask the client to sit still for 30 seconds.
- D. Count respirations while pretending to check the client's pulse.
Correct Answer: D
Rationale: The best technique to determine a client's respiratory rate is to count respirations while pretending to check the client's pulse. You should not inform the client that you are counting their respirations, as this might lead to a change in their breathing pattern. Pretending to check the pulse allows you to be close to the client without revealing that you are assessing their respiratory rate. Asking the client to sit still may not be as effective, as it may cause them to concentrate on their breathing. Watching from across the room may not provide an accurate assessment of respirations, as they might be difficult to observe.
A nurse is trying to motivate a client toward more effective management of a therapeutic regimen. Which of the following actions by the nurse is most likely to be effective in increasing the client's motivation?
- A. determining whether the client has any family or friends living nearby
- B. developing a lengthy discharge plan and reviewing it carefully with the client
- C. teaching the client about the disorder at the client's level of understanding
- D. making a referral to an area agency for client followup
Correct Answer: C
Rationale: For maximum effectiveness, teach the client about the disorder at the client's level of understanding.
A 37-year-old female client asks the nurse about contraception options and expresses interest in oral contraception pills. Which of the following statements would indicate that oral contraception is appropriate for this client?
- A. "I quit smoking last year, but I started again recently. Maybe I'll try to quit later this year."?
- B. "I am very diligent in taking my thyroid medications at the same time every day."?
- C. "I was hospitalized for deep vein thrombosis five years ago."?
- D. "I was recently diagnosed with breast cancer."?
Correct Answer: C
Rationale: The correct answer is the statement mentioning a history of deep vein thrombosis five years ago. Oral contraceptives are generally not recommended for individuals with a history of deep vein thrombosis due to the increased risk of blood clots. Choice B, about being diligent in taking thyroid medications, does not directly relate to the safety of using oral contraceptives. Choice D, about a recent breast cancer diagnosis, would contraindicate the use of hormonal contraceptives. Choice A, mentioning a recent return to smoking, raises concerns about using hormonal contraceptives due to the increased risk of cardiovascular complications.
During the health screening of an adolescent, which finding by the nurse requires further teaching?
- A. The client started her first menses 2 years ago.
- B. The client states she is currently on birth control pills.
- C. The client states she recently lost 5 pounds.
- D. The client states she is experiencing growing pains.
Correct Answer: B
Rationale: Because the client is on the pill, she requires further teaching regarding protection against STDs. The other findings are not abnormal for an adolescent.
A nurse has been ordered to set-up Buck's traction on a patient's lower extremity due to a femur fracture. Which of the following applies to Buck's traction?
- A. A weight greater than $10 \mathrm{lbs}$. should be used.
- B. The line of pull is upward at an angle.
- C. The line of pull is straight
- D. A weight greater than $20 \mathrm{lbs}$. should be used.
Correct Answer: C
Rationale: A straight line of pull is indicated with Buck's traction.