Nokea
Which best describes signs and symptoms as part of a nursing diagnosis?
- A. Description of potential risk factors
- B. Identification of actual health problems
- C. Human response to state of illness or health
- D. Cues and clusters derived from patient assessment
Correct Answer: D
Rationale: Signs and symptoms are cues and clusters derived from patient assessments that are used to form a nursing diagnosis, guiding the development of a care plan.
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Which physiological acid-base balance complication would be most important for the nurse to assess in a patient with diarrhea?
- A. High serum pH
- B. Normal serum pH
- C. Metabolic alkalosis
- D. Metabolic acidosis
Correct Answer: D
Rationale: The correct answer is metabolic acidosis. Diarrhea can lead to the loss of bicarbonate, causing an imbalance in the acid-base status of the body, specifically resulting in metabolic acidosis. High serum pH (choice A) is incorrect as diarrhea-induced bicarbonate loss would lower pH, not increase it. Normal serum pH (choice B) is not the best answer as diarrhea can disrupt the acid-base balance. Metabolic alkalosis (choice C) is an alkaline state, which is less likely to be caused by diarrhea.
Several types of seizures can occur in neonates. What is characteristic of clonic seizures?
- A. Apnea
- B. Tremors
- C. Extension of all four limbs
- D. Jerking that cannot be stopped by flexion of the affected limb
Correct Answer: D
Rationale: Clonic seizures are characterized by slow, rhythmic, jerking movements that cannot be stopped by flexion of the affected limb. Therefore, the correct characteristic of clonic seizures is option D. Option A, apnea, is not characteristic of clonic seizures. Option B, tremors, does not describe clonic seizures accurately. Option C, extension of all four limbs, is not a typical feature of clonic seizures but rather seen in tonic seizures.
The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate?
- A. Strong evidence from unbiased observational studies
- B. Evidence from randomized clinical trials showed inconsistent results
- C. Consistent evidence from well-performed randomized clinical trials
- D. Evidence for at least one critical outcome from randomized clinical trials had serious flaws
Correct Answer: B
Rationale: Moderate evidence typically indicates that results from randomized clinical trials were inconsistent, highlighting the need for further research to confirm findings.
The nurse is conducting a teaching session for parents on nutrition. Which characteristics of families should the nurse consider that can cause families to struggle in providing adequate nutrition? (Select all that apply.)
- A. Homelessness
- B. Lower income
- C. Migrant status
- D. All of the above
Correct Answer: D
Rationale: Factors like homelessness, lower income, and migrant status can create barriers to providing adequate nutrition for children.
The educator is teaching about the process of physical growth and development. Which of these describes the directional pattern from head to tail?
- A. Cephalodistal
- B. Cephalocaudal
- C. Proximodistal
- D. Proximocaudal
Correct Answer: B
Rationale: Cephalocaudal development is the correct term that describes the directional pattern of growth from head to tail. This means that the head and upper body parts develop before the lower parts. Choice A, 'Cephalodistal,' refers to growth from the center of the body outward, not head to tail. Choice C, 'Proximodistal,' describes growth from the center of the body towards the extremities, not specifically from head to tail. Choice D, 'Proximocaudal,' is not a recognized term in the context of physical growth and development.