Nokea
What is the primary theory that explains a family's concept of health and illness?
- A. Health Belief Model
- B. Education-School-Completing Factor
- C. Family Health Expert Factor
- D. Disconnected Family Factor
Correct Answer: A
Rationale: The Health Belief Model describes readiness factors; the perceived feelings of susceptibility and seriousness of the health problem (the threat); and positive motivation to maintain, regain, or attain wellness.
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The LPN needs to delegate a task to the nurse aide who is new to the unit. Which of these is the best option for the nurse to choose in proceeding?
- A. Delegate the task to the nurse aide, confirm understanding, and follow up to ensure the task was safely/correctly done.
- B. Delegate the task to the nurse aide, watch them perform the task without them seeing you, and follow up to ensure the task was done safely/accurately.
- C. Delegate the task to the nurse aide, supervise if needed and check in after the task to see if help is needed.
- D. Delegate the task to the nurse aide, ensure understanding of the task, and supervise task being performed.
Correct Answer: A
Rationale: Delegation is transferring responsibility for a task but sharing its accountability. It is the delegator's responsibility to make sure the delegatee understands the task prior and to follow up after to make sure it was done correctly and safely.
The ICU nurse caring for a client who has just been declared brain dead can expect to find evidence of the client's wishes regarding organ donation:
- A. on the driver's license of the client.
- B. in the client's safety deposit box.
- C. in the client's last will and testament.
- D. on the client's insurance card.
Correct Answer: A
Rationale: In most states, indication of organ donor status is found on the driver's license. Evidence in a last will and testament or in a safety deposit box is not readily accessible for decision-making if the need arises. Insurance cards do not contain such information.
While performing a physical assessment on a 6-month-old infant, the nurse observes head lag. Which of the following nursing actions should the nurse perform first?
- A. Ask the parents to allow the infant to lay on her stomach to promote muscle development
- B. Notify the physician because a developmental or neurological evaluation is indicated
- C. Document the findings as normal in the nurse's notes
- D. Explain to the parents that their child is likely to be mentally retarded
Correct Answer: B
Rationale: Persistent head lag at 6 months suggests developmental or neurological issues, warranting immediate physician referral for evaluation.
Diagnostic genetic counseling, for procedures such as amniocentesis and chorionic villus sampling, allows clients to make all of the following choices except:
- A. terminating the pregnancy.
- B. preparing for the birth of a child with special needs.
- C. accessing support services before the birth.
- D. completing the grieving process before the birth.
Correct Answer: D
Rationale: If findings are ominous, the grieving process will not be completed before birth. If the couple elects to terminate a pregnancy based on diagnostic tests, there will be grief and concerns for future pregnancies. Couples might choose to access support services and prepare for the birth of an infant with special needs. Some fetal conditions can be treated in utero.
The nurse uses prioritization to determine all the following except:
- A. time allotment for certain tasks.
- B. appropriate interventions.
- C. treatment procedures.
- D. the need for client education.
Correct Answer: C
Rationale: Treatment procedures are standards of care as defined by the facility or nursing unit. If a treatment is indicated, the nurse is obligated to follow the established procedure to be compliant with practice standards. Established priorities contribute to the determination of time management, appropriate interventions, and the need for client education as a potential intervention.