Nokea
What prevents disorientation in older clients with hearing impairments?
- A. Use of written notes and a walking cane for proper balance
- B. Refer to a local support or self-help group
- C. Frequent contact and reorientation
- D. Avoid frequent outdoor activities
Correct Answer: C
Rationale: Regular reorientation and interaction help maintain cognitive and spatial awareness.
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Which traits are clients with anorexia nervosa noted to have?
- A. Low self-esteem
- B. High self-esteem
- C. Perfectionism
- D. Intense desire to displease others
Correct Answer: C
Rationale: Perfectionism is a common trait among individuals with anorexia nervosa, driving their pursuit of unrealistic body ideals.
Scheduling the administration of analgesics every __ hours often affords a uniform level of pain relief.
- A. Every 2 hours
- B. Every 3-4 hours
- C. Every 6 hours
- D. Every 7 hours
Correct Answer: B
Rationale: The rationale for this is that administering analgesics on a regular schedule (e.g., every 3-4 hours) helps maintain a steady level of medication in the bloodstream, providing consistent pain relief.
What is most important to determine when completing Mr. Anderson’s nursing history?
- A. Known allergy to penicillin
- B. Work habits
- C. History of COPD
- D. Sleep and rest habits
Correct Answer: A
Rationale: Penicillin allergy is critical to know before administering antibiotics.
Which stage of wound healing lasts from 21 days to several months and even 1 to 2 years, allowing the strength of the wound to increase through synthesis of collagen by fibroblasts and lysis by collagenase enzymes?
- A. Inflammatory stage
- B. Proliferative phase
- C. Maturation phase
- D. Approximation phase
Correct Answer: C
Rationale: The correct answer is C because the maturation phase involves collagen remodeling and strengthening.
When preparing a client for transfer to the ICU for placement of a pulmonary artery catheter, the nurse should explain that this catheter is used to monitor which of the following conditions?
- A. Intracranial pressure
- B. Spinal cord perfusion
- C. Renal function
- D. Hemodynamic status
Correct Answer: D
Rationale: The correct answer is D: Hemodynamic status. A pulmonary artery catheter is used to monitor hemodynamic parameters such as cardiac output, pulmonary artery pressure, and central venous pressure. This helps assess the patient's circulatory status and guide interventions in critically ill patients.
Explanation:
1. Pulmonary artery catheter measures cardiac output and helps in assessing the heart's ability to pump blood effectively.
2. It provides information on pulmonary artery pressure which reflects the pressure in the right side of the heart and pulmonary circulation.
3. Central venous pressure is also monitored, indicating the fluid status and right heart function.
Summary:
A: Intracranial pressure - Incorrect. Pulmonary artery catheter does not monitor intracranial pressure.
B: Spinal cord perfusion - Incorrect. Pulmonary artery catheter does not monitor spinal cord perfusion.
C: Renal function - Incorrect. Pulmonary artery catheter does not monitor renal function.