Nokea
When the nurse placed the patient in restraints before using other methods of intervention, she/he violated the patient's rights to ______.
- A. receive confidential and respectful care
- B. provide informed consent
- C. receive treatment in the least restrictive environment
- D. refuse treatment
Correct Answer: C
Rationale: Placing a patient in restraints before utilizing other less restrictive interventions violates the patient's right to receive treatment in the least restrictive environment. Restraints should be used as a last resort when all other options have been exhausted, as they can be restrictive to the patient's movement and freedom. Patients have the right to be treated in a manner that minimizes limitations on their personal freedom and autonomy. Restraints should only be utilized when absolutely necessary for the safety of the patient or others.
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Based on the 2017 demography report (July 2016 estimate), the Philippine population has reached:
- A. 140 million
- B. 102 million
- C. 120 million
- D. 85 million
Correct Answer: B
Rationale: According to the 2017 demography report based on the July 2016 estimate, the Philippine population was approximately 102 million. This data is derived from official census data and estimates made by the Philippine Statistics Authority. As of that time, the country's population had not reached 140 million, 120 million, or 85 million as the other options suggest.
What is the purpose of a tracheostomy. To _______.
- A. Establish an airway
- B. Monitor respiratory functions
- C. Establish a pathway for nutrition
- D. Maintain the patency of the airway
Correct Answer: A
Rationale: The purpose of a tracheostomy is to establish an artificial airway in the trachea through a surgical procedure. This is done to bypass obstructions in the upper airway, assist with breathing, or facilitate the removal of secretions from the lungs. A tracheostomy helps in maintaining a clear and secure airway for patients who have difficulty breathing or require long-term mechanical ventilation support.
A postpartum client presents with persistent, severe perineal pain despite analgesic medication. On assessment, the nurse observes ecchymosis and swelling of the perineum. Which nursing action is most appropriate?
- A. Applying ice packs to the perineum for pain relief
- B. Encouraging the client to sit on a donut cushion
- C. Notifying the healthcare provider immediately
- D. Administering additional analgesic medication
Correct Answer: C
Rationale: The presence of persistent, severe perineal pain along with ecchymosis and swelling of the perineum can indicate a complication such as a hematoma. A hematoma is a collection of blood that can occur in the perineal area postpartum, usually as a result of trauma during delivery. It is essential to notify the healthcare provider immediately to assess the situation, provide appropriate treatment, and prevent further complications. Applying ice packs or administering additional analgesic medication may not address the underlying issue of a possible hematoma, so prompt medical evaluation is crucial in this situation.
Upon clinical assessment, the nurse observes that the OUTSTANDING manifestation of the patient is ______.
- A. weight gain
- B. obesity
- C. emaciation
- D. edema
Correct Answer: D
Rationale: Upon clinical assessment, the nurse observes that the outstanding manifestation of the patient is edema. Edema is characterized by the accumulation of excess fluid in the body's tissues, leading to swelling. Edema can be a sign of various health conditions, such as heart failure, kidney disease, liver disease, or injury. It is crucial to identify and address the underlying cause of edema promptly to prevent complications and provide appropriate treatment for the patient.
Weight loss and Malnutrition are commonly observed among patients with COPD. They should be taught to avoid ______.
- A. have full stomach even when in dyspneic condition
- B. keeping body mass between 21-25 kg./m
- C. a high caloric and high protein diet
- D. exercise one hour before and after eating
Correct Answer: A
Rationale: Patients with COPD often experience dyspnea, which makes it difficult for them to breathe. When they have a full stomach, their diaphragm is compressed, which can further increase difficulty in breathing. Teaching patients with COPD to avoid having a full stomach even when in dyspneic condition is important to prevent exacerbation of breathing problems. It is advisable for them to have small, frequent meals to ensure adequate nutrition without compromising their ability to breathe comfortably.