Nokea
When reinforcing teaching and instructing the patient, which basic principle of teaching should you follow?
- A. Sequence the instruction from the least complex to the most complex.
- B. Assume that the patient knows little or nothing about the topic.
- C. Tell the patient to call their significant other so you can instruct them.
- D. Use medically oriented terms so the patient will be able to speak with the doctor.
Correct Answer: A
Rationale: The correct principle of teaching to follow when reinforcing teaching and instructing the patient is to sequence the instruction from the least complex to the most complex. This approach facilitates learning by building upon simpler concepts before moving to more advanced ones. Choice B is incorrect because assuming the patient knows little or nothing about the topic may not always be accurate and can be patronizing. Choice C is incorrect as it does not focus on the direct teaching approach to the patient. Choice D is incorrect as using medically oriented terms may confuse the patient rather than facilitate understanding.
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A client with DM states, 'I cannot eat big meals; I prefer to snack throughout the day.' The nurse should carefully explain that the:
- A. Regulated food intake is crucial for control
- B. Restricting salt and sugar is the main concern
- C. Opting for small, frequent meals aids digestion
- D. Consuming large meals can contribute to weight issues
Correct Answer: A
Rationale: In clients with diabetes, regulated food intake is crucial for controlling blood glucose levels. Choice A is the correct answer because maintaining consistent meal sizes and timings helps in managing blood sugar levels effectively. Choice B is incorrect because while monitoring salt and sugar intake is important, it is not the primary consideration in this scenario. Choice C is incorrect as the focus is on regulating food intake rather than aiding digestion. Choice D is also incorrect because consuming large meals can indeed lead to fluctuations in blood glucose levels, but the primary concern in this case is the regulation of food intake for better control of diabetes.
A charge nurse is making staff assignments on a medical-surgical unit. Which of the following tasks should the nurse plan to delegate to an assistive personnel?
- A. Measuring oxygen saturation for a client who has dyspnea
- B. Inserting a rectal suppository for a client who is vomiting
- C. Performing nasal hygiene for a client who has an NG tube
- D. Pouching a client's ostomy bag for a new colostomy
Correct Answer: D
Rationale: Pouching a new colostomy is a task that can be safely and appropriately delegated to an assistive personnel as it falls within their scope of practice. Measuring oxygen saturation (Choice A) requires a higher level of training and assessment, making it unsuitable for delegation. Inserting a rectal suppository (Choice B) and performing nasal hygiene (Choice C) involve invasive procedures that are typically performed by licensed nursing staff due to the associated risks and complexities, making them inappropriate for delegation to assistive personnel.
What is the role of a nurse in a multidisciplinary healthcare team?
- A. Working independently without consulting others
- B. Coordinating patient care with other team members
- C. Ignoring patient concerns
- D. Making all healthcare decisions alone
Correct Answer: B
Rationale: The correct answer is B: 'Coordinating patient care with other team members.' In a multidisciplinary healthcare team, nurses collaborate with other healthcare professionals to ensure comprehensive care for patients. Working independently without consulting others (choice A) is not aligned with the collaborative nature of multidisciplinary teams. Ignoring patient concerns (choice C) goes against the core principles of patient-centered care. Making all healthcare decisions alone (choice D) contradicts the teamwork approach of a multidisciplinary team.
A nurse at a long-term care facility is planning a fall prevention program for the residents. Which of the following interventions should the nurse include?
- A. Apply vest restraints to residents who are confused
- B. Keep all four side rails up on beds at night
- C. Accompany residents over 85 years of age during ambulation
- D. Implement rounds every 2 hours during the day to offer toileting
Correct Answer: D
Rationale: The correct answer is to implement rounds every 2 hours during the day to offer toileting. This intervention helps prevent falls by addressing the common cause of unassisted mobility, which is the need to use the bathroom. Choice A is incorrect as restraints should not be the first choice for fall prevention due to the risk of injury and loss of independence. Choice B is incorrect because all side rails up can lead to entrapment and should only be used based on individualized assessments. Choice C may not be feasible for all residents over 85 years old and does not directly address the risk of falls.
Which statement about glaucoma is true and accurate?
- A. Acute angle-closure glaucoma is an ocular emergency.
- B. Acute angle-closure glaucoma leads to the loss of peripheral vision and tunnel vision.
- C. Primary open-angle glaucoma leads to eye pain, nausea, and vomiting, blurry vision, and halos.
- D. Bubbles are implanted to protect the retina from glaucoma.
Correct Answer: A
Rationale: The correct answer is A: 'Acute angle-closure glaucoma is an ocular emergency.' Acute angle-closure glaucoma is indeed considered an ocular emergency that requires immediate attention to prevent vision loss. Choice B is incorrect because acute angle-closure glaucoma commonly presents with symptoms like severe eye pain, headache, blurred vision, and halos around lights. Choice C is incorrect as these symptoms are more indicative of acute angle-closure glaucoma rather than primary open-angle glaucoma. Choice D is incorrect since bubbles are not typically used to protect the retina from glaucoma; treatment usually involves medications, laser therapy, or surgery to manage intraocular pressure.