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Which of the following is an expected reaction from a client who has just been told by the physician that his tumor is malignant and has metastasis in to several organs?
- A. Crying uncontrollably
- B. Criticizing medical care
- C. Refusing to visit visitors
- D. Asking for additional medical consultations
Correct Answer: A
Rationale: A malignant, metastatic diagnosis often triggers grief's depression stage (Kübler-Ross), with crying as a natural emotional release. Criticism, withdrawal, or seeking consultations may reflect denial or bargaining, less immediate than sorrow. Nurses expect and support this reaction, offering empathy and presence, facilitating coping as patients process a life-altering prognosis, critical for emotional care.
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The nurse listened to Mr. Gary to build trust. This is an example of?
- A. Therapeutic communication
- B. Reflective practice
- C. Health promotion
- D. Care transition
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The 5-minute Apgar of a baby delivered by C-section is recorded as 9. The most likely reason for this score is:
- A. The mottled appearance of the trunk
- B. The presence of conjunctival hemorrhages
- C. Cyanosis of the hands and feet
- D. Respiratory rate of 20-28 per minute
Correct Answer: C
Rationale: A 5-minute Apgar score of 9 typically reflects one point deduction, often for color, with cyanosis of the hands and feet (acrocyanosis) being common in newborns, especially post-C-section, due to initial circulation adjustments. Mottling or hemorrhages don't directly score points off, and a respiratory rate of 20-28 is low (normal is 30-60), potentially docking more points. Nurses recognize acrocyanosis as benign, resolving naturally, and use this score to reassure parents while monitoring transition, ensuring no further intervention is needed.
A healthcare professional is educating a client with osteoporosis about dietary management. Which of the following foods should the professional recommend?
- A. Green beans
- B. Fortified cereal
- C. Red meat
- D. White bread
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client hospitalized with a fractured mandible is to be discharged. Which piece of equipment should be kept on the client with a fractured mandible?
- A. Wire cutters
- B. Oral airway
- C. Pliers
- D. Tracheostomy set
Correct Answer: A
Rationale: Wire cutters are essential for a client with a fractured mandible, often wired shut for immobilization, to cut wires in emergencies like vomiting or airway obstruction, ensuring safety post-discharge. An oral airway, pliers, or tracheostomy set isn't standard for this condition wires are the focus. Nurses emphasize this precaution, teaching clients and families its use, preventing complications from restricted jaw movement during healing.
The nurse is assigning tasks to the unlicensed assistive personnel (UAP). Which task should not be delegated to the UAP?
- A. Obtaining the client's weight
- B. Collecting a stool specimen
- C. Recording the client's intake and output
- D. Evaluating the client's pain level
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.