Nokea
Which of the following services is not part of family consultation?
- A. assisting with vocational rehabilitation
- B. providing information about the client's illness
- C. teaching effective communication
- D. helping families solve problems
Correct Answer: A
Rationale: Family consultation does not involve vocational rehabilitation. It involves helping families deal with their feelings, focus, and find solutions. Choices 2, 3, and 4 are components of family consultation.
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Which of the following viruses is most likely to be acquired through casual contact with an infected individual?
- A. influenza virus
- B. herpes virus
- C. cytomegalovirus (CMV)
- D. human immunodeficiency virus (HIV)
Correct Answer: A
Rationale: Influenza virus is transmitted through respiratory droplets. Herpes virus is transmitted by direct contact, and HIV is transmitted through blood and body fluids. Cytomegalovirus is an opportunistic infection.
The PN is caring for a client with diabetes insipidus. The nurse can expect the lab work to show:
- A. elevated urine osmolarity and elevated serum osmolarity.
- B. decreased urine osmolarity and decreased serum osmolarity.
- C. elevated urine osmolarity and decreased serum osmolarity.
- D. decreased urine osmolarity and elevated serum osmolarity.
Correct Answer: D
Rationale: In diabetes insipidus, the pituitary releases too much antidiuretic hormone (ADH) causing the client to produce a large amount of dilute (decreased osmolarity) urine and causing dehydration (elevated serum osmolarity). Choice 3 might be seen in a client with SIADH (syndrome of inappropriate ADH). Choices 1 and 2 generally don't occur- urine and serum osmolarity typically move in opposite directions.
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.
Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashley's level of anxiety as:
- A. mild.
- B. moderate.
- C. severe.
- D. panic.
Correct Answer: C
Rationale: The person whose anxiety is assessed as severe is unable to solve problems and has a poor grasp of what's happening in his or her environment. Somatic symptoms such as those described by Ashley are usually present. Vital sign changes are observed. The individual with mild anxiety might report being mildly uncomfortable and might even find performance enhanced. The individual with moderate anxiety grasps less information about the situation, has some difficulty problem-solving, and might have mild changes in vital signs. The individual in panic demonstrates markedly disturbed behavior and might lose touch with reality.
When questioning an elder about suspected abuse, the nurse should keep the questions:
- A. nonjudgmental.
- B. probing.
- C. confrontational.
- D. indirect.
Correct Answer: A
Rationale: Questions about suspected abuse should be direct and nonconfrontational. Indirect questions encourage denial.