Nokea
Which risk factor should the nurse include as the best predictor of future violence?
- A. Previous violent behavior
- B. Low self-esteem
- C. Substance use disorder
- D. A history of depression
Correct Answer: A
Rationale: The correct answer is A: Previous violent behavior. This is the best predictor of future violence because past behavior is a strong indicator of future actions. Individuals who have a history of violent behavior are more likely to exhibit violent tendencies again. Low self-esteem (B), substance use disorder (C), and a history of depression (D) can contribute to increased risk of violence, but they are not as reliable predictors as previous violent behavior. A history of violence is a key factor in assessing the potential for future violent acts.
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The client is at greatest risk for developing -----and-------
- A. Placental abruption
- B. Hypoglycemia
- C. Heart failure
- D. Cervical Insufficiency
- E. Seizures
Correct Answer: A,E
Rationale: The correct answer is A (Placental abruption) and E (Seizures) because they are common complications during pregnancy. Placental abruption poses a risk of severe bleeding and fetal distress, leading to adverse outcomes. Seizures, specifically eclampsia, can occur due to uncontrolled hypertension in pregnancy, putting both the mother and baby at risk. Hypoglycemia (B), heart failure (C), and cervical insufficiency (D) are potential complications but are not the greatest risks compared to placental abruption and seizures in this context.
Which of the following actions should the nurse take to promote learning?
- A. Speak loudly when addressing the client
- B. Connect new information with the client's past experiences
- C. Present the information to the client using abstract concepts
- D. Use a 12 point font when printing written material for the client
Correct Answer: B
Rationale: The correct answer is B: Connect new information with the client's past experiences. This promotes learning by linking new concepts to existing knowledge, aiding in retention and understanding. Speaking loudly (A) may not enhance learning and can be off-putting. Presenting information abstractly (C) may confuse the client. Using a 12 point font (D) is a formatting preference and does not directly impact learning.
Which of the following medications should the nurse identify as being incompatible with warfarin?
- A. Naproxen
- B. Metformin
- C. Lisinopril
- D. Albuterol
Correct Answer: A
Rationale: The correct answer is A: Naproxen. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding when taken with warfarin, an anticoagulant. This is due to their combined effects on blood clotting. Metformin, Lisinopril, and Albuterol do not have a significant interaction with warfarin in terms of bleeding risk. Therefore, the nurse should identify Naproxen as incompatible with warfarin to prevent potential adverse effects.
Select the 5 complications the client is at risk for.
- A. Hypertension
- B. Hypocalcemia
- C. Calcium resorption
- D. Urinary stasis
- E. Contractures
- F. Atelectasis
- G. Diarrhea
Correct Answer: C,D,E,F,H
Rationale: Immobility increases risks of urinary stasis, contractures, atelectasis, and pressure injuries.
Which of the following statements should the nurse include in the hand-off report?
- A. The estimated blood loss was 250 mL.
- B. The client has a good appetite and ate well before surgery.
- C. The client's family visited during the recovery period.
- D. The client's call light is within reach.
Correct Answer: A
Rationale: The correct answer is A: The estimated blood loss was 250 mL. This statement is important for the receiving nurse to know as it provides crucial information about the client's condition post-surgery. It helps in monitoring for signs of hemorrhage or other complications. The other choices (B, C, D) are not essential for the hand-off report as they do not directly impact the client's immediate care or safety. Choice B is subjective and not a clinical observation. Choice C is about the client's family, which is not pertinent to the client's medical status. Choice D is a general safety measure and not specific to the client's condition.