Nokea
Which of the following actions should the nurse plan to take?
- A. Launch a media campaign to increase awareness about industrial pollution
- B. Have a nurse from outside the community provide health lectures at the county hospital
- C. Encourage rural residents to focus health spending on tertiary health interventions
- D. Provide anticipatory guidance classes to parents through public schools
Correct Answer: D
Rationale: The correct answer is D because providing anticipatory guidance classes to parents through public schools is a proactive approach to promote health and prevent illness in the community. This action empowers parents with knowledge and skills to make informed health decisions for their children. Launching a media campaign (A) may raise awareness but may not directly impact individual behavior change. Having a nurse from outside the community provide health lectures (B) may not be as effective as someone familiar with the community's specific needs. Encouraging rural residents to focus on tertiary health interventions (C) is reactive and may not address prevention.
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Which of the following questions is the priority for the nurse to ask the client?
- A. How do you manage your behavior?
- B. Do you have a criminal record?
- C. How do you get along with your peers at school?
- D. Do you have thoughts of harming yourself?
Correct Answer: D
Rationale: The correct answer is D. The nurse's priority is to assess for any immediate danger or harm to the client. Asking about thoughts of harming oneself is crucial in determining the client's safety. This question helps identify the client's risk of suicide and allows for timely intervention if needed. Choices A, B, and C focus on different aspects of the client's behavior and relationships, which are important but not as urgent as assessing for suicidal ideation. It is essential to address safety concerns first before exploring other areas.
Which of the following findings should the nurse expect?
- A. Spotting
- B. Nausea
- C. Polyhydramnios
- D. Uterine tenderness
Correct Answer: A
Rationale: The correct answer is A: Spotting. Spotting is a common finding in early pregnancy due to implantation bleeding or hormonal changes. It is often a normal occurrence, especially in the first trimester. Nausea (choice B) is another common finding in early pregnancy, known as morning sickness. Polyhydramnios (choice C) is an excessive accumulation of amniotic fluid and is not typically an expected finding. Uterine tenderness (choice D) can be a sign of infection or other issues, not a typical finding in early pregnancy.
Which of the following interventions should the nurse include?
- A. Assess the child for frequent swallowing
- B. Carefully suction the child's oropharynx to remove secretions
- C. Administer pancreatic enzymes with meals
- D. Continuously monitor the child's respiratory status
Correct Answer: A
Rationale: Frequent swallowing indicates airway obstruction risks.
The nurse should first anticipate-------, followed by-----------
- A. obtain IV access
- B. place the client o a supine position with feet elevated
- C. recheck the diene's oxygen saturation
- D. Call the surgical suite to notify that the client is arriving STAT
- E. prepare to administer TV fluids
- F. check an arterial blood gas
- G. check an ECG
Correct Answer: A,E
Rationale: The correct answer is A, obtain IV access, and E, prepare to administer IV fluids. First, obtaining IV access is essential to establish a route for administering medications and fluids. This step is crucial in a critical situation to ensure quick access for emergency interventions. Next, preparing to administer IV fluids is important to address potential fluid imbalances or hypovolemia in the client. The other choices are incorrect because placing the client in a supine position with feet elevated (B) may be contraindicated in certain conditions, rechecking oxygen saturation (C) may delay urgent interventions, calling the surgical suite (D) is premature without stabilizing the client first, checking an arterial blood gas (F) and ECG (G) are important but not immediate priorities in this scenario.
For each potential provider's prescription, click to specify if the potential prescription is anticipated or unanticipated for the client.
- A. Place client in supine position
- B. Limit fluid intake to 3,000 mL/day
- C. Administer oxytocin
- D. Maintain bed rest with bathroom privileges
- E. Administer betamethasone.
- F. Administer terbutaline.
Correct Answer: D,E,F
Rationale: [0, 0, 0, 1, 1, 1]
For the correct answer :
- D: Maintaining bed rest with bathroom privileges is anticipated as it helps in preventing physical strain while allowing essential movement.
- E: Administering betamethasone is anticipated for fetal lung maturation in preterm labor.
- F: Administering terbutaline is anticipated for delaying preterm labor by relaxing uterine muscles.
Other choices:
- A: Placing the client in a supine position is not anticipated as it can decrease blood flow to the fetus.
- B: Limiting fluid intake to 3,000 mL/day is not anticipated as hydration is vital during pregnancy.
- C: Administering oxytocin is not anticipated unless there is a specific indication for labor induction.