Nokea
Which of the following lab values would indicate symptomatic AIDS in the medical chart? (T4 cell count per deciliter)
- A. Greater than 1000 cells per deciliter
- B. Less than 500 cells per deciliter
- C. Greater than 2000 cells per deciliter
- D. Less than 200 cells per deciliter
Correct Answer: D
Rationale: A T4 cell count less than 200 cells per deciliter indicates symptomatic AIDS, as it reflects severe immunosuppression.
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The nurse should utilize data about which of the following to provide information about the nutritional status of a client being evaluated for malnutrition?
- A. triceps skinfold measurement
- B. fasting blood glucose level
- C. hemoglobin A1c level
- D. serum lipid profile results
Correct Answer: A
Rationale: Objective anthropometric measurements such as triceps skinfold and mid-arm circumference (MAC), along with weight, are usually used to diagnose malnutrition. While all the other choices represent tests that might provide useful information, they also might be affected by variables other than malnutrition.
The nurse can best communicate to a client that he or she has been listening by:
- A. restating the main feeling or thought the client has expressed.
- B. making a judgment about the client's problem.
- C. offering a leading question such as, 'And then what happened?'
- D. saying, 'I understand what you're saying.'
Correct Answer: A
Rationale: Restating allows the client to validate the nurse's understanding of what has been communicated. It's an active listening technique. Judgments should be suspended in a nurse-client relationship. Leading questions ask for more information rather than showing understanding. Saying 'I understand' communicates understanding, but the client has no way of measuring the understanding.
During the work phase of the nurse-client relationship, the client says to her primary nurse, 'You think that I could walk if I wanted to, don't you?' What is the best response by the nurse?
- A. Yes, if you really wanted to, you could.
- B. Tell me why you're concerned about what I think.
- C. Do you think you could walk if you wanted to?
- D. I think you're unable to walk now, whatever the cause.
Correct Answer: D
Rationale: This response answers the question honestly and nonjudgmentally and helps to preserve the client's self-esteem. Choice 1 is an open and candid response but diminishes the client's self-esteem. Choice 2 doesn't answer the client's question and is not helpful. Choice 3 increases the client's anxiety because her inability to walk might be directly related to an unconscious psychological conflict that has not been resolved.
A 21-year-old college student has just learned that she contracted genital herpes from her sexual partner. After completing the initial history and assessment, the nurse has data concerning areas pertinent to the disease. The data is likely to include all but which of the following?
- A. voiding patterns
- B. characteristics of lesions
- C. vaginal discharge
- D. prior history of varicella
Correct Answer: D
Rationale: The other choices are common reasons for which clients with herpes seek care.
A hospitalized client has just been informed that he has terminal cancer. He says to the nurse, 'There must be some mistake in the diagnosis.' The nurse determines that the client is demonstrating which of the following?
- A. denial
- B. anger
- C. bargaining
- D. acceptance
Correct Answer: A
Rationale: Denial (Kübler-Ross's Stages of Grieving) is the refusal to believe that loss is happening.