Nokea
Which of the following statement is TRUE about evaluation in nursing process?
- A. First step of the process
- B. Determines if goals are met
- C. Only done once
- D. All of the above
Correct Answer: B
Rationale: Evaluation determines if goals are met (B), per process e.g., pain reduced? Not first (A, assessment), not once (C, ongoing), not all (D) outcome-focused. B truly defines evaluation's role, making it correct.
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A client attached to mechanical ventilation suddenly becomes restless and pulls out the tracheostomy tube. Which is the nurse's priority intervention?
- A. Prepare for reintubation.
- B. Call the health care provider.
- C. Call the rapid response team.
- D. Check the client for spontaneous breathing.
Correct Answer: D
Rationale: If a tracheostomy tube is dislodged, checking for spontaneous breathing (D) is the priority to assess airway patency and oxygenation need. Preparing for reintubation (A) or calling teams (B, C) follows. D is correct. Rationale: Assessing breathing determines if immediate reinsertion or oxygenation is urgent, guiding next steps per respiratory emergency standards, ensuring patient stability first.
Myra, 21 year old nursing student has difficulty sleeping. She told Nurse Budek 'I really think a lot about my x boyfriend recently' Budek told Myra 'And that causes you difficulty sleeping?' Which therapeutic technique is used in this situation?
- A. Reflecting
- B. Restating
- C. Exploring
- D. Seeking clarification
Correct Answer: D
Rationale: Budek's 'And that causes you difficulty sleeping?' seeks clarification (D), asking Myra to confirm the link between her ex and insomnia. Reflecting (A) mirrors feelings (e.g., 'You're upset?'). Restating (B) repeats (e.g., 'You think about him a lot?'). Exploring (C) probes broadly. Clarification ensures understanding, per therapeutic models, fitting Budek's intent, making D correct.
Considered as Safest and most non invasive method of temperature taking
- A. Oral
- B. Rectal
- C. Tympanic
- D. Axillary
Correct Answer: D
Rationale: Axillary temp is safest, least invasive no mucosal entry e.g., armpit avoids rectal (perforation), oral (biting), or tympanic (ear) risks. Ideal for infants, nurses use it e.g., frail patients for safety, per non-invasive guidelines.
Which of the following statement best describe battery in nursing?
- A. A verbal threat
- B. Unconsented physical contact
- C. A legal fine
- D. A care plan
Correct Answer: B
Rationale: Battery is unconsented physical contact (B), per law e.g., touching without permission. Not threat (A, assault), not fine (C), not plan (D) contact-based. B best defines battery's violation, like touching Mr. Gary against will, making it correct.
Which of the following statement is TRUE about palliative care?
- A. Palliative care is given only on Hospice setting
- B. Palliative care is given only to cancer clients
- C. Palliative care improves quality of life
- D. Palliative care is offered only when the client's condition is irreversible
Correct Answer: C
Rationale: Palliative care improves quality of life (C), per its goal managing symptoms, enhancing comfort. It's not hospice-only (A), not cancer-specific (B), and applies beyond irreversible states (D) available at any serious illness stage. C's universal truth aligns with palliative principles, making it correct.