Nokea
Which of the following foods is a complete protein?
- A. Eggs
- B. Corn
- C. Peanuts
- D. Sunflower seeds
Correct Answer: B
Rationale: The correct answer is A: Eggs. Eggs are considered a complete protein because they contain all 9 essential amino acids required by the human body. This makes them a high-quality protein source. Corn (B), peanuts (C), and sunflower seeds (D) are not complete proteins as they lack one or more of the essential amino acids. Corn is deficient in lysine, peanuts are deficient in methionine, and sunflower seeds are deficient in lysine. Therefore, only eggs provide all the essential amino acids necessary for optimal health and proper bodily functions.
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What is the primary concern for a nurse caring for a client who is post-operative and experiencing confusion?
- A. Notify the healthcare provider
- B. Reorient the client
- C. Increase circulation
- D. Assess the level of pain
Correct Answer: B
Rationale: The correct answer is B: Reorient the client. Reorientation helps the confused client regain awareness of their surroundings, time, and situation post-operatively. It can improve their cognition and reduce anxiety. Notifying the healthcare provider (A) may be necessary but not the primary concern. Increasing circulation (C) is important but not the first step for a confused post-op client. Assessing pain (D) is important but addressing confusion takes precedence.
Which of the following actions is the nurse's priority when caring for a client with a head injury?
- A. Monitor the client's airway
- B. Administer pain relief
- C. Perform a CT scan
- D. Monitor intracranial pressure
Correct Answer: A
Rationale: The correct answer is A: Monitor the client's airway. This is the priority because airway management is crucial in ensuring adequate oxygenation and ventilation, which is essential for brain function in a client with a head injury. Maintaining a clear airway takes precedence over other actions such as administering pain relief, performing a CT scan, or monitoring intracranial pressure. While these actions are important, ensuring the client's airway is patent and adequate oxygenation is crucial for preventing further brain injury or complications.
What does a comprehensive assessment include?
- A. Complete health history and physical exam
- B. Specific focus on a body system
- C. Emergency triage
- D. Specific assessment of client complaints
Correct Answer: A
Rationale: The correct answer is A because a comprehensive assessment involves gathering a complete health history and conducting a thorough physical examination to evaluate the client's overall health status. This includes assessing past medical history, family history, current medications, lifestyle factors, and performing a head-to-toe physical examination. This holistic approach helps in identifying any potential health issues or risk factors.
Choice B is incorrect because a specific focus on a body system is not comprehensive and may miss other important aspects of the client's health.
Choice C is incorrect as emergency triage is a rapid assessment to determine the severity of a medical condition and prioritize treatment, not a comprehensive assessment.
Choice D is incorrect because a specific assessment of client complaints is focused only on the reported issues and may not provide a comprehensive overview of the client's health.
A nurse is assessing a patient with chronic liver disease. The nurse should monitor for signs of which of the following complications?
- A. Hypoglycemia.
- B. Hyperkalemia.
- C. Jaundice.
- D. Anemia.
Correct Answer: C
Rationale: The correct answer is C: Jaundice. In chronic liver disease, the liver's ability to process bilirubin is impaired, leading to jaundice. This is characterized by a yellowing of the skin and eyes. Monitoring for jaundice is crucial as it indicates liver dysfunction. Hypoglycemia (A) is not a typical complication of chronic liver disease. Hyperkalemia (B) is more commonly associated with kidney dysfunction. Anemia (D) can occur in liver disease but is not as specific a complication as jaundice. Therefore, monitoring for jaundice in a patient with chronic liver disease is essential for early detection and management of liver dysfunction.
What is the most important nursing intervention for a client with severe dehydration?
- A. Administer IV fluids
- B. Monitor vital signs
- C. Provide oral rehydration
- D. Administer oxygen
Correct Answer: A
Rationale: The correct answer is A: Administer IV fluids. This is the most important nursing intervention for a client with severe dehydration because IV fluids provide rapid rehydration and help restore electrolyte balance efficiently. Monitoring vital signs (choice B) is important but not as crucial as providing immediate fluid replacement. Providing oral rehydration (choice C) may not be effective for severe dehydration as the client may have difficulty absorbing fluids orally. Administering oxygen (choice D) is not directly related to treating dehydration, so it is not the most important intervention in this scenario.