Nokea
Which of the following is NOT a contraindication in taking ORAL temperature?
- A. Quadriplegic
- B. Presence of NGT
- C. Dyspnea
- D. Nausea and Vomitting
Correct Answer: A
Rationale: Quadriplegia isn't an oral temp contraindication e.g., a paralyzed patient can hold a thermometer if alert. NGT (obstruction), dyspnea (breathing), and nausea (gagging) preclude it. Nurses opt for alternatives e.g., axillary per safety protocols.
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When you discover an electrical fire and decide you need a fire extinguisher, you will need to find a fire extinguisher that is rated for which class of fire?
- A. Class A
- B. Class B
- C. Class C
- D. Class E
Correct Answer: C
Rationale: An electrical fire requires a Class C extinguisher, designed for energized electrical equipment like appliances or wiring. Class A suits ordinary combustibles (wood), Class B handles flammable liquids, and Class E isn't standard (often confused with electrical but not U.S.-classified). Using a Class C extinguisher, typically with non-conductive agents like carbon dioxide, ensures safety by avoiding shock while extinguishing. This choice protects both the nurse and client in a healthcare setting, aligning with fire safety protocols.
The nurse gave pain medication to Mr. Gary even if he did not ask for it because she assessed that he is in pain. This is an example of?
- A. Autonomy
- B. Beneficence
- C. Justice
- D. Fidelity
Correct Answer: B
Rationale: Giving pain meds unasked, based on assessed need, is beneficence (B) doing good, per ethics. Autonomy (A) respects choice, justice (C) fairness, fidelity (D) promises not proactive care. B fits promoting well-being, making it correct.
The nurse is providing dietary instruction for a client with hypoglycemia. To prevent hypoglycemic reactions, the nurse should instruct the client to:
- A. Eat a candy bar if he feels lightheaded
- B. Always carry a quick source of sugar
- C. Limit his intake of fluids with meals
- D. Avoid eating large meals
Correct Answer: B
Rationale: Carrying a quick sugar source (e.g., glucose tabs) prevents hypoglycemic reactions by rapidly raising blood sugar candy is less precise, fluid limits are unrelated, and large meals don't directly cause drops. Nurses teach this, ensuring safety, critical for hypoglycemia management.
Which of the following statement best describe spiritual care in nursing?
- A. Ignoring beliefs
- B. Supporting spiritual needs
- C. A medical fix
- D. A one-time talk
Correct Answer: B
Rationale: Spiritual care is supporting spiritual needs (B), per nursing e.g., prayer support. Not ignoring (A), not medical (C), not one-time (D) holistic focus. B best defines its role, enhancing Mr. Gary's well-being, making it correct.
These are nursing intervention that requires knowledge, skills and expertise of multiple health professionals.
- A. Dependent
- B. Independent
- C. Interdependent
- D. Intradependent
Correct Answer: C
Rationale: Interdependent interventions involve collaboration across health disciplines e.g., a nurse and dietician planning a high-protein diet for nephrotic syndrome. Unlike dependent (physician-ordered), independent (nurse-initiated), or intradependent (non-existent), these require shared expertise, ensuring comprehensive care. This teamwork, common in complex cases, leverages diverse skills for optimal outcomes, a staple in multidisciplinary healthcare settings.