Nokea
Which practice is recommended to prevent human immune deficiency virus
(HIV) transmission by health care workers?
- A. Wearing a mask within three feet of the client
- B. Using standard precautions
- C. Applying hand sanitizer to gloves during cares
- D. Double gloving
Correct Answer: B
Rationale:
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Which of the following lab tests should NOT be used for diagnosing connective tissue
diseases?
- A. Rheumatoid factor (RF)
- B. Erythrocyte sedimentation rate (ESR)
- C. Anti-nuclear antibody (ANA)
- D. Thyroid stimulating hormone (TSH)
Correct Answer: D
Rationale:
A client is in the emergency room in critical condition and hypotensive. Her
spouse is distraught. What is the priority nursing action?
- A. Maintain the client's blood pressure
- B. Call a chaplain
- C. Provide the spouse a chair
- D. Ask the client's spouse to explain what happened
Correct Answer: A
Rationale:
A client with acquired immunodeficiency syndrome (AIDS) has pneumocystis
carinii (PCP). What is the nurse's priority assessment for this client?
- A. Skin turgor
- B. Lung sounds
- C. Radial pulses
- D. Capillary refill
Correct Answer: B
Rationale:
A provider has ordered a wound culture for a client with a non-healing wound.
What is the nurse's first action?
- A. Label the specimen tube
- B. Put on non-sterile gloves
- C. Gently remove the soiled dressings
- D. Irrigate the wound
Correct Answer: B
Rationale:
A client does not understand why vision loss due to glaucoma is irreversible. What is the nurse's best explanation?
- A. Once retinal detachment occurs, it does not return to its normal state
- B. Once the tissue has necrosed from high-pressure, it does not regenerate
- C. Glaucoma always leads to permanent blindness
- D. Once bacterial infection has caused damage, the tissue does not regenerate
Correct Answer: B
Rationale: The correct explanation for irreversible vision loss in glaucoma is that once the tissue has necrosed from high pressure, it does not regenerate. This necrosis occurs due to the damage caused by increased intraocular pressure, which leads to irreversible damage to the optic nerve and retinal tissue. Choices A, C, and D are incorrect because they do not directly address the specific mechanism of irreversible vision loss in glaucoma, which is necrosis due to high pressure.