Nokea
When meeting nurses for the first time, a new nurse manager makes eye contact, smiles, initiates conversation about their previous work experience, and encourages active participation. This behavior is an example of
- A. aggressiveness
- B. passive aggressiveness
- C. passiveness
- D. assertiveness
Correct Answer: D
Rationale: The nurse manager is demonstrating assertive behavior by confidently engaging with the nurses through eye contact, smiling, and encouraging participation. This behavior shows a balance between expressing her own opinions and respecting others. Aggressive behavior would involve dominating or embarrassing others, while passive behavior is characterized by being timid or nervous. Passive-aggressive behavior is indirect and manipulative, which is not demonstrated in this scenario.
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A 2-year-old child diagnosed with HIV comes to a clinic for immunizations. Which of the following vaccines should the nurse expect to administer in addition to the scheduled vaccines?
- A. pneumococcal vaccine
- B. hepatitis A vaccine
- C. Lyme disease vaccine
- D. typhoid vaccine
Correct Answer: A
Rationale: For a 2-year-old child diagnosed with HIV, in addition to the scheduled vaccines, the nurse should expect to administer the pneumococcal vaccine. Children with HIV are at an increased risk of infections, including pneumococcal disease. The pneumococcal vaccine helps protect against serious pneumococcal infections like pneumonia, meningitis, and bacteremia. The hepatitis A vaccine is not specifically recommended for all children with HIV unless there are specific risk factors. The Lyme disease vaccine is for individuals at risk for Lyme disease, typically between the ages of 15 and 70, transmitted by ticks. The typhoid vaccine is usually recommended for individuals traveling to endemic areas or working in specific high-risk occupations like microbiology laboratories dealing with Salmonella typhi.
The greatest time savers when planning client care include all of the following except:
- A. reacting to the crisis of the moment
- B. setting goals
- C. planning
- D. specifying priorities
Correct Answer: A
Rationale: The greatest time-savers when planning client care are activities that facilitate focus and completion of priority items. Time-savers include setting goals, specifying priorities, planning tasks, delegating where appropriate, reassessment, and ongoing evaluation of needs. Reacting to the crisis of the moment is not a time-saving strategy in client care planning; it can lead to inefficiency, lack of focus, and potentially missing important priority items. Therefore, the correct answer is 'reacting to the crisis of the moment.' Choices B, C, and D are essential components for effective client care planning as they help in organizing and prioritizing tasks, setting objectives, and ensuring a structured approach to care delivery.
Following the change of shift report, when can or should the nurse's plan be altered or modified during the shift?
- A. halfway through the shift
- B. at the end of the shift before the nurse reports off
- C. when needs change
- D. after the top-priority tasks have been completed
Correct Answer: C
Rationale: The correct answer is 'when needs change.' It is crucial for the nurse to remain adaptable and adjust the plan promptly when the patient's needs or condition change. Choice A, 'halfway through the shift,' may not align with the timing of when needs actually change, making it less optimal for plan modifications. Choice B, 'at the end of the shift before the nurse reports off,' is too late to address evolving needs effectively. Choice D, 'after the top-priority tasks have been completed,' limits the nurse's ability to respond promptly to changing priorities, as needs may shift before all top-priority tasks are finished.
When testing the function of the oculomotor, trochlear, and abducens nerves, which parameter does a nurse check to determine their function?
- A. Tongue symmetry
- B. Eye movements
- C. Facial symmetry
- D. Corneal reflex
Correct Answer: B
Rationale: The correct answer is B: Eye movements. When assessing the oculomotor, trochlear, and abducens nerves, evaluating eye movements is crucial. This assessment includes checking the pupils for size, regularity, equality, light reactions, accommodation, and extraocular movements in various gaze positions. Tongue symmetry is primarily used to evaluate cranial nerve XII (hypoglossal nerve) function. Facial symmetry is a key indicator of cranial nerve VII (facial nerve) function. The corneal reflex assesses sensory afferents in cranial nerve V (trigeminal nerve) and motor efferents in cranial nerve VII (facial nerve).
When assessing the health-related physical fitness of a client as part of a health assessment, what aspect should be the focus?
- A. agility
- B. speed
- C. body composition
- D. risk factors
Correct Answer: D
Rationale: When assessing the health-related physical fitness of a client, the primary focus should be on identifying risk factors that could predispose the client to illness or injury. Risk factors are crucial in determining an individual's overall health status and potential health outcomes. While agility, speed, and body composition are important components of physical fitness assessments, they are not the primary focus when assessing health-related physical fitness from a holistic perspective. Therefore, the correct choice is 'risk factors.'