Nokea
Which of the following would be appropriate to delegate to the nursing assistant?
- A. Assist the child to remove outer clothing
- B. Advise the parent to use acetaminophen instead of aspirin
- C. Explain the need for cool fluids
- D. Prepare and administer a tepid bath
Correct Answer: A
Rationale: Removing outer clothing is a simple task that does not require clinical judgment.
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Which indicates a person selected on the client’s behalf to make medical decisions when the client cannot?
- A. Durable power of attorney for healthcare
- B. Living will
- C. Advance directive
- D. Informed consent
Correct Answer: A
Rationale: A durable power of attorney for healthcare designates a proxy decision-maker, ensuring the client's wishes are honored.
What is the best strategy for communicating with clients with Limited English Proficiency (LEP)?
- A. Ask a family member to translate.
- B. Request a telephonic interpreter.
- C. Request a certified interpreter.
- D. Ask a bilingual staff member to interpret.
Correct Answer: C
Rationale: Certified interpreters ensure accurate and culturally sensitive communication, minimizing errors and misunderstandings.
A nurse is teaching a client who is obese and has obstructive sleep apnea how to decrease the number of nightly
apneic episodes. Which of the following client statements indicates an understanding of the teaching?
- A. "It might help if I tried sleeping only on my back."
- B. "I'll sleep better if I take a sleeping pill at night."
- C. "I'll get a humidifier to run at my bedside at night."
- D. "If I could lose about 50 pounds, I might stop having so many apneic episodes."
Correct Answer: D
Rationale: The correct answer is D because losing weight can help reduce the severity and frequency of obstructive sleep apnea. Excess weight can lead to fat deposits around the upper airway, causing obstruction during sleep. By losing weight, the airway may become less obstructed, reducing apneic episodes.
Choice A is incorrect because sleeping on the back can actually worsen sleep apnea by causing the tongue and soft tissues to block the airway.
Choice B is incorrect because sleeping pills can relax the muscles in the airway, making it more likely for an individual with sleep apnea to experience episodes of apnea.
Choice C is incorrect because while a humidifier can alleviate some symptoms like dryness, it does not directly address the underlying cause of obstructive sleep apnea related to obesity.
When caring for a client with pain, which of the following is essential throughout the client’s care?
- A. Giving assurance that pain management is a nursing and agency priority.
- B. Giving assurance that pain relief will be immediate and effective.
- C. Giving assurance that pain relief will be permanent.
- D. Giving assurance that pain has a psychological basis and can be easily managed.
Correct Answer: A
Rationale: The correct answer is A because ensuring that pain management is prioritized by both nursing staff and the healthcare facility is crucial for consistent and effective care.
Your patient's physician told him that he has hemophilia. You are asked to teach the signs and symptoms of this disease. You respond by saying
- A. Clot formation, especially in the veins of the lower extremities.
- B. Low blood counts and fatigue due to lack of adequate red blood cell production.
- C. High blood counts and clot formation under the nails.
- D. Excessive bleeding after minor trauma.
Correct Answer: D
Rationale: Hemophilia is characterized by excessive bleeding due to a deficiency in clotting factors.