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Which of the following statements is correct about Maslow's hierarchy of needs?
- A. There are psychosocial interventions that may be applicable to all of the levels.
- B. There are physical interventions that may be applicable to all of the levels.
- C. Two of the levels may require physical intervention while four of the levels may require psychosocial intervention.
- D. Four of the levels may require physical intervention, while two of the levels may require psychosocial intervention.
Correct Answer: C
Rationale: In Maslow's hierarchy of needs, two of the levels, physiological needs and safety and security needs, may require physical interventions. Four of the levels, safety and security needs, love and belonging needs, self-esteem needs, and self-actualization needs may require psychosocial intervention. Safety and security needs may require physical or psychosocial intervention.
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The nurse is evaluating the effectiveness of lispro and glargine insulins being administered to the 2-year-old with type 1 DM. Which findings on the serum laboratory report indicate that treatment is effective?
- A. Blood glucose
- B. Hgb A1c
- C. Creatinine
- D. WBCs
Correct Answer: A, B
Rationale: The treatment goal for children with type 1 DM is blood glucose levels within the normal range (60-105 mg/dL for a 2-year-old). Hgb A1c levels are indicative of the average blood glucose levels over the past 2 to 3 months; normal A1c is 3.9% to 7.7%. Although the other laboratory values are normal, these do not indicate the effectiveness of insulin therapy.
When caring for pediatric clients, the nurse should pay special attention to the psychosocial development stages credited to ?
- A. Robert Peck
- B. Erik Erikson
- C. Sigmund Freud
- D. Jean Piaget
Correct Answer: B
Rationale: Erik Erikson is credited with the psychosocial development theory and eight stages. The nurse should take these stages into account when caring for pediatric clients to assess their development. Jean Piaget is responsible for cognitive development. Sigmund Freud is responsible for psychosexual development. Robert Peck is responsible for aging theory.
The nurse is caring for the client who has received sumatriptan. The nurse evaluates that sumatriptan has been an effective treatment when the client reports which change?
- A. An improvement in mood
- B. A decrease in muscle spasms
- C. An increased ability to fall asleep
- D. Relief of migraine headache attacks
Correct Answer: D
Rationale: A: Sumatriptan is not used in the treatment of mood alterations. B: Sumatriptan is not used in the treatment of muscle spasms. C: Sumatriptan is not used in the treatment of insomnia. D: Sumatriptan (Imitrex) is a serotonin receptor agonist and a first-line medication for terminating a migraine or cluster headache attack.
The nurse is reviewing the chart illustrated of the client diagnosed with stage III HF. Which conclusion should the nurse make?
- A. The medications should be administered as prescribed.
- B. The client may be experiencing toxicity from digoxin.
- C. Hyperkalemia likely caused the client's cardiac dysrhythmias.
- D. Seeing halos can result from the atrial fibrillation or anticoagulants.
Correct Answer: B
Rationale: A: The digoxin should be withheld and not given until a serum digoxin level is determined. B: Signs of digoxin (Lanoxin) toxicity include seeing yellow halos around objects and dysrhythmias. The furosemide (Lasix) diuretic increases urinary excretion of potassium and can cause hypokalemia. Hypokalemia can contribute to both cardiac dysrhythmias and digoxin toxicity. C: A serum potassium level of 2.9 mEq/L indicates hypokalemia, not hyperkalemia. D: The yellow vision is a characteristic sign of digoxin toxicity and is not a sign of cerebral damage from an infarct due to atrial fibrillation or bleeding from the anticoagulants.
The LPN is caring for a client newly diagnosed with HIV. Which statement made by the client regarding antiretroviral therapy (ART) would require correction from the nurse?
- A. If I start ART and use condoms, I'm less likely to transmit HIV to my partner.
- B. I can still use ART even though I am Hepatitis C positive.
- C. I will need to be on ART indefinitely.
- D. I know I will need to come back for blood draws so that I can begin ART when my CD4 count is over 1,000 cells/mm3.
Correct Answer: D
Rationale: The World Health Organization (WHO) recommends making treatment for those with a CD4 count of ≤ 350 cells/mm3 a priority, as early intervention can help delay disease progression. Studies have shown that ART can reduce HIV transmission to sexual partners by up to 96%. Conditions such as pregnancy and Hepatitis B and C increase the need to initiate therapy sooner and are in no way contraindicated. ART does not cure HIV, but to maintain viral suppression, it should be continued indefinitely.