When assessing a client with anxiety disorder, what does the nurse observe for evidence of various levels of anxiety?
- A. Absence of crying
- B. Talking excessively
- C. Being motionless
- D. Not complaining
Correct Answer: B
Rationale: Excessive talking may indicate heightened anxiety as the client attempts to distract themselves from their worries.
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A nurse cares for a female client who has a family history of cystic fibrosis. The client asks, Will my children have cystic fibrosis? How should the nurse respond?
- A. Since many of your family members are carriers, your children will also be carriers of the gene.
- B. Cystic fibrosis is an autosomal recessive disorder. If you are a carrier, your children will have the disorder.
- C. Since you have a family history of cystic fibrosis, I would encourage you & your partner to be tested.
- D. Cystic fibrosis is caused by a protein that controls the movement of chloride. Adjusting your diet will decrease the spread of this disorder.
Correct Answer: C
Rationale: Rationale:
C is correct because it encourages genetic testing for both the client and their partner to assess the risk of passing on the cystic fibrosis gene. This approach provides the necessary information for informed decision-making regarding family planning. A is incorrect because being a carrier does not guarantee that the children will also be carriers. B is incorrect as it inaccurately states that if the client is a carrier, their children will have the disorder. D is incorrect because it oversimplifies the etiology of cystic fibrosis and suggests dietary adjustments as a solution, which is not effective in managing the genetic condition.
A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain?
- A. Treatment includes the use of adjuvant analgesics
- B. Will be chronic in nature and require long-term treatment
- C. Responds to small to moderate around-the-clock doses of oral opioids
- D. Can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs)
Correct Answer: B
Rationale: The correct answer is B. Trigeminal neuralgia is chronic and often requires long-term management.
When caring for a client with acute pancreatitis, what intervention is most appropriate?
- A. Encourage a high-protein diet.
- B. Administer pain medication as needed.
- C. Provide small, frequent meals.
- D. Increase oral fluid intake.
Correct Answer: B
Rationale: The correct answer is B: Administer pain medication as needed. In acute pancreatitis, pain management is crucial to provide comfort and improve outcomes. Pain medication helps alleviate the severe abdominal pain associated with pancreatitis. It is essential to treat pain promptly to prevent complications and improve the client's quality of life. Encouraging a high-protein diet (A) is not recommended as it may exacerbate pancreatitis symptoms. Providing small, frequent meals (C) may help reduce the workload on the pancreas, but pain management takes precedence. Increasing oral fluid intake (D) is important for hydration but does not address the primary concern of pain relief in acute pancreatitis.
What behavioral clues will you watch for to identify an increased risk for suicide?
- A. Deep breathing exercises
- B. Avoid social interactions
- C. Ignore stressors
- D. Increase workload
Correct Answer: D
Rationale: The correct answer is D because it is the most appropriate response based on physiological and medical principles.
Which manipulative and body-based technique uses pressure applied to the feet and hands?
- A. Massage
- B. Reflexology
- C. Shiatsu
- D. Chiropractic technique
Correct Answer: B
Rationale: Reflexology applies pressure to specific points on the feet and hands, stimulating corresponding body areas.