Nokea
Which of the following statement best describe crisis?
- A. A chronic condition
- B. A sudden event disrupting homeostasis
- C. A minor inconvenience
- D. A permanent state
Correct Answer: B
Rationale: Crisis is a sudden event disrupting homeostasis (B), per Caplan overwhelming balance (e.g., loss). Chronic (A) is ongoing, minor (C) understates, permanent (D) misframes crisis resolves. B best defines crisis's acute nature, making it correct.
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Which of the following statement is TRUE about patient safety?
- A. Only about medication
- B. Prevents harm in care
- C. Not a nursing concern
- D. All of the above
Correct Answer: B
Rationale: Patient safety prevents harm in care (B), per standards e.g., fall prevention. Not just meds (A), is nursing concern (C), not all (D) broad focus. B truly defines safety's aim, making it correct.
A patient is characterized with a #16 indwelling urinary (Foley) catheter to determine if:
- A. Trauma has occurred
- B. His 24-hour output is adequate
- C. He has a urinary tract infection
- D. Residual urine remains in the bladder after voiding
Correct Answer: B
Rationale: A Foley catheter monitors 24-hour urine output for adequacy.
What equipment would be necessary to complete an evaluation of cranial nerves 9 and 10 during a physical assessment?
- A. A cotton ball
- B. A penlight
- C. An ophthalmoscope
- D. A tongue depressor and flashlight
Correct Answer: D
Rationale: Cranial nerves 9 and 10 (glossopharyngeal and vagus) are assessed with a gag reflex, requiring a tongue depressor and light.
A client is scheduled for a computed tomography (CT) of the brain with contrast. When reviewing the client's medical record, what significant finding should the nurse report to the primary healthcare provider before the diagnostic procedure?
- A. The client takes metformin daily.
- B. The client has not been nothing by mouth (NPO).
- C. The client reports an allergy to gadolinium.
- D. The client was not prescribed a bowel prep.
Correct Answer: A
Rationale: Metformin (A) is significant before a CT with contrast due to lactic acidosis risk if renal function declines from contrast dye. NPO status (B) isn't critical for brain CT. Gadolinium (C) is MRI-related, not CT. Bowel prep (D) is irrelevant. A is correct. Rationale: Contrast can impair kidneys, exacerbating metformin toxicity, requiring provider adjustment, per radiology safety protocols.
The nurse is caring for a client following a transurethral resection of the prostate (TURP). Which finding should be reported to the physician immediately?
- A. Bright red urine 12 hours post-op
- B. Urine output of 30 mL/hour
- C. Complaints of bladder spasms
- D. Temperature of 100.2°F
Correct Answer: A
Rationale: Bright red urine 12 hours post-TURP suggests active bleeding, abnormal beyond initial pink-tinged output, requiring immediate physician report low output, spasms, or mild fever are less urgent. Nurses flag this, as hemorrhage risks clot retention or shock, prompting irrigation or intervention.