Nokea
What is the first intervention when a client is showing signs of shock after surgery?
- A. Administer blood transfusion
- B. Monitor for arrhythmias
- C. Administer oxygen
- D. Encourage deep breathing
Correct Answer: B
Rationale: The correct answer is B: Monitor for arrhythmias. This is because in a client showing signs of shock after surgery, the priority is to assess for any cardiac complications such as arrhythmias, which can be life-threatening. Monitoring for arrhythmias allows prompt identification and intervention. Administering a blood transfusion (A) may be necessary in some cases of shock but is not the first intervention. Administering oxygen (C) may also be necessary, but addressing cardiac complications takes precedence. Encouraging deep breathing (D) is not a priority in managing shock-related complications.
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Which of the following is the most appropriate response for a nurse caring for a client who is experiencing a stroke?
- A. Perform a neurological assessment
- B. Initiate a stroke protocol
- C. Position the client on their side
- D. Start a CT scan
Correct Answer: B
Rationale: The correct answer is B: Initiate a stroke protocol. This is the most appropriate response because time is critical in treating a stroke. By initiating a stroke protocol, the nurse ensures that the client receives prompt and appropriate care, including timely evaluation, imaging studies, and potential interventions such as administering clot-busting medication. Performing a neurological assessment (A) is important but may delay crucial interventions. Positioning the client on their side (C) is essential for airway protection but should not be the initial priority. Starting a CT scan (D) is important for diagnosis but should not delay the initiation of the stroke protocol, which includes obtaining imaging studies.
What is the primary concern for a nurse caring for a client who is post-operative and experiencing confusion?
- A. Notify the healthcare provider
- B. Reorient the client
- C. Increase circulation
- D. Assess the level of pain
Correct Answer: B
Rationale: The correct answer is B: Reorient the client. Reorientation helps the confused client regain awareness of their surroundings, time, and situation post-operatively. It can improve their cognition and reduce anxiety. Notifying the healthcare provider (A) may be necessary but not the primary concern. Increasing circulation (C) is important but not the first step for a confused post-op client. Assessing pain (D) is important but addressing confusion takes precedence.
A nurse is caring for a patient with a history of chronic kidney disease. The nurse should monitor for which of the following complications related to decreased renal function?
- A. Hyperkalemia.
- B. Hypoglycemia.
- C. Hypotension.
- D. Hypercalcemia.
Correct Answer: A
Rationale: The correct answer is A: Hyperkalemia. In chronic kidney disease, the kidneys are unable to effectively excrete potassium, leading to elevated levels in the blood. This can result in life-threatening cardiac arrhythmias. Monitoring for hyperkalemia is crucial in managing patients with kidney disease.
Other choices are incorrect because:
B: Hypoglycemia is not typically associated with chronic kidney disease.
C: Hypotension may occur in kidney disease but is not directly related to decreased renal function.
D: Hypercalcemia is not a common complication of decreased renal function; in fact, kidney disease can lead to low levels of calcium.
Which factors increase the risk of sexually transmitted diseases (STDs)?
- A. alcohol use
- B. certain types of sexual practices
- C. oral contraception use
- D. all of the above
Correct Answer: D
Rationale: The correct answer is D: all of the above. Alcohol use can impair judgment leading to risky sexual behaviors. Certain sexual practices like unprotected sex or having multiple partners increase STD risk. Oral contraception does not protect against STDs. Therefore, all factors (A, B, C) collectively increase the risk of STDs.
Which of the following statements accurately describes the concept of culturally competent care?
- A. The health care provider is able to understand and speak the patient's mother tongue.
- B. The health care provider possesses a basic knowledge of the patient's cultural background.
- C. The health care provider has knowledge of the significance of social, economic, and cultural contexts.
- D. The health care provider applies knowledge, skills, attitudes, and personal attributes to maximize respect and care.
Correct Answer: D
Rationale: Step 1: Culturally competent care involves applying knowledge, skills, attitudes, and personal attributes to provide respectful and effective care.
Step 2: Understanding and speaking the patient's mother tongue (Option A) is important but not sufficient for culturally competent care.
Step 3: Possessing basic knowledge of the patient's cultural background (Option B) is helpful, but not comprehensive enough to ensure culturally competent care.
Step 4: Having knowledge of the significance of social, economic, and cultural contexts (Option C) is crucial but does not encompass the full scope of culturally competent care.
Step 5: The correct answer, D, encompasses the holistic approach needed for culturally competent care by emphasizing the application of knowledge, skills, attitudes, and personal attributes to maximize respect and care.