Nokea
Treatment of a patient without consent can constitute which is defined as intentional and unwanting touching.
- A. battery
- B. negligence
- C. slander
- D. tort
Correct Answer: A
Rationale: The correct answer is A: battery. Battery is the intentional and unwanted touching of another person without their consent, which can include medical treatment without consent. This is a clear violation of the patient's autonomy and can lead to legal consequences. Negligence (B) is the failure to exercise reasonable care, not intentional touching. Slander (C) is making false spoken statements that harm someone's reputation. Tort (D) is a broader term referring to civil wrongs, including battery, but not specifically addressing intentional and unwanted touching.
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Nurse Chona read in one nurse's notes chart this documentation: "Refused to eat and fell from bed". Which of the following is lacking in this documentation?
- A. Time of complaint, for missed and reaction on fall incurred.
- B. Referrals made on fall medications given and reasons of falling.
- C. Contents or complaints, reasons of refusing meal and nature of fall.
- D. Time of eating, medications for back pain and intense of pain.
Correct Answer: C
Rationale: The correct answer is C because the documentation lacks essential details regarding the contents of the complaints, reasons for refusing the meal, and the nature of the fall. This information is crucial for understanding the patient's condition and providing appropriate care. Choice A is not directly related to the documentation provided. Choice B is about referrals and medications, which are not mentioned in the documentation. Choice D is about eating time and medications for pain, which are also not relevant to the documentation provided. Therefore, the correct answer is C as it addresses the specific missing information in the nurse's notes.
Which of the following actions should be taken first when encountering a person experiencing an allergic reaction with signs of respiratory distress?
- A. Administer an epinephrine auto-injector.
- B. Position the person comfortably.
- C. Monitor vital signs.
- D. Assess the severity of the reaction.
Correct Answer: D
Rationale: The correct answer is D: Assess the severity of the reaction. This should be the first action taken because it helps determine the urgency of the situation and guides subsequent steps. Assessing the severity allows for appropriate intervention - from calling emergency services if the reaction is severe, to administering medication if necessary.
A: Administering an epinephrine auto-injector should only be done if the severity of the reaction warrants it, as it is a potent medication that can have serious side effects if used inappropriately.
B: Positioning the person comfortably is important, but assessing the severity of the reaction takes precedence to ensure prompt and appropriate care.
C: Monitoring vital signs is important, but assessing the severity of the reaction is crucial in determining the immediate course of action.
Upon entry of the patient to ER, the nurse must FIRST perform which nursing intervention?
- A. Inject with rabies immune globulin.
- B. Cleanse the bite with soap and running water.
- C. Inject the rabies vaccine immediately.
- D. Administer the pain reliever, as ordered.
Correct Answer: B
Rationale: The correct answer is B: Cleanse the bite with soap and running water. This is the first nursing intervention because it is crucial to prevent infection. Cleaning the bite area helps remove bacteria and debris, reducing the risk of infection. Injecting with rabies immune globulin (choice A) and rabies vaccine (choice C) should be done later as per protocol after assessing the situation. Administering pain reliever (choice D) is important but not the first priority in this scenario.
While patient Sarah is confined in the hospital, the safety measure to be observed by the nurses is prevention from fall. This is brought about by the patient being prone to fracture as a result of________.
- A. aging process
- B. osteoporosis
- C. change in vision
- D. hematologic condition
Correct Answer: B
Rationale: The correct answer is B: osteoporosis. Osteoporosis is a condition characterized by weakened bones, making individuals more susceptible to fractures, especially with minor trauma or falls. In the context of a patient prone to fractures, nurses should be particularly cautious about fall prevention.
A: The aging process alone does not necessarily lead to an increased risk of fractures. While aging is a risk factor for osteoporosis, it is not the direct cause of fractures in this case.
C: Changes in vision can contribute to an increased risk of falls, but it is not the primary reason for the patient being prone to fractures in this scenario.
D: Hematologic conditions may affect bone health, but they are not typically the primary cause of increased fracture risk in patients.
In her recommendation, Nurse Gina stated, elderly should be given independence. This means ________.
- A. They must live on their own
- B. The environment should be safe for them
- C. They are free what to do
- D. They have rights
Correct Answer: C
Rationale: The correct answer is C because independence for the elderly means they have the freedom to make choices and decisions about their own lives. This empowers them to live according to their preferences and values. Choice A is incorrect because it doesn't consider individual circumstances; choice B is important but doesn't capture the essence of independence; choice D is too broad and doesn't specifically address the concept of personal autonomy and agency for the elderly.