When performing a physical examination, what approach is most important for the nurse to use?
- A. A head-to-toe approach to avoid missing an important area
- B. The same systematic, efficient sequence for all examinations
- C. A sequence that is least revealing and embarrassing for the patient
- D. An approach that allows time to collect the nursing history data while performing the examination
Correct Answer: B
Rationale: The correct answer is 'The same systematic, efficient sequence for all examinations.' Consistency ensures thoroughness and reduces the likelihood of missing critical details.
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Describe the differences in action of SSRIs, SNRIs, and atypical antidepressants.
- A. High blood pressure
- B. Increased heart rate
- C. Decreased oxygen supply
- D. Muscle relaxation
Correct Answer: D
Rationale: The correct answer is D because it is the most appropriate response based on physiological and medical principles.
What is contraindicated for a client being treated for Ménière’s disease?
- A. Alcohol
- B. Smoking
- C. A high-protein diet
- D. Cough syrups and other CNS depressants
Correct Answer: D
Rationale: CNS depressants can worsen dizziness and imbalance associated with Ménière’s disease.
What is the role of antiviral medications in treating herpes zoster ophthalmicus?
- A. Reduce viral replication
- B. Prevent bacterial infection
- C. Correct vision
- D. None of the above
Correct Answer: A
Rationale: Antivirals target the varicella-zoster virus, reducing its replication and severity.
A client is in the immediate postoperative period following a partial laryngectomy. Which of the following parameters should the nurse assess first?
- A. Pain severity
- B. Wound drainage
- C. Tissue integrity
- D. Airway patency
Correct Answer: D
Rationale: The correct answer is D: Airway patency. Assessing airway patency is the priority in the immediate postoperative period following a laryngectomy to ensure the client's ability to breathe. If the airway is compromised, it can lead to life-threatening complications. Pain severity (A), wound drainage (B), and tissue integrity (C) are important assessments but are secondary to ensuring the client's airway is clear and functioning properly. Prioritizing airway patency allows for prompt intervention if any issues arise, ensuring the client's safety and optimal recovery.
Priority Decision: The husband and daughter of a Hispanic woman dying from pancreatic cancer refuse to consider using hospice care. What is the first thing the nurse should do?
- A. Assess their understanding of what hospice care services are.
- B. Ask them how they will care for the patient without hospice care.
- C. Talk directly to the patient and family to see if she can change their minds.
- D. Accept their decision since they are Hispanic and prefer to care for their own.
Correct Answer: A
Rationale: The nurse should assess their understanding of hospice care services to ensure they are making an informed decision based on accurate information rather than assumptions or cultural biases.
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