Nokea
Nurse is planning care for a child during admission to the facility. Which action should the nurse take first?
- A. Obtain a prescription for pain medication.
- B. Collect blood cultures
- C. Transport the child to obtain a CT scan.
- D. Initiate seizure precautions.
Correct Answer: D
Rationale: Positive Brudzinski's and Kernig's signs indicate meningitis, making seizure precautions the priority to prevent complications.
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Which of the following actions should the nurse take?
- A. Keep visitors at least 6 feet(1.8 m) away from the client.
- B. Place the client's soiled bed linens in a biohazard bag outside the client's room.
- C. Wear an isolation gown when caring for the client.
- D. Discard the radioactive source in the client's trash can.
Correct Answer: B
Rationale: The correct answer is B: Place the client's soiled bed linens in a biohazard bag outside the client's room. This is the correct action to prevent the spread of infection, as soiled linens may contain infectious agents. Keeping visitors 6 feet away (choice A) is related to social distancing, not linens handling. Choice C, wearing an isolation gown, is important but not directly related to handling soiled linens. Discarding a radioactive source in the trash can (choice D) is unsafe and violates radiation safety protocols.
Which of the following interventions should the nurse include to support the client's nutritional requirements?
- A. Keep a calorie count for foods and beverages
- B. Provide a high-calorie, high-protein diet
- C. Encourage a low-fat diet to prevent digestive issues
- D. Restrict oral intake and provide IV fluids only
Correct Answer: B
Rationale: The correct answer is B: Provide a high-calorie, high-protein diet. This intervention supports the client's nutritional requirements by ensuring they receive adequate energy and protein for healing and overall health. High-calorie intake can prevent malnutrition, while high-protein intake supports tissue repair and immune function. Keeping a calorie count (A) is helpful but not as crucial as ensuring the client receives enough calories and protein. Encouraging a low-fat diet (C) is not the priority when aiming to meet nutritional requirements. Restricting oral intake (D) and providing IV fluids only can lead to malnutrition and should be avoided.
The nurse understands that the patient has likely developed lithium toxicity and will be monitored for-------
- A. blood glucose levels
- B. seizure activity
- C. symptoms of infection
- D. temperature over 39.4° C(103\ F)"
Correct Answer: B
Rationale: The correct answer is B: seizure activity. Lithium toxicity can lead to neurological symptoms including seizures. Monitoring for seizure activity is crucial to prevent serious complications. Blood glucose levels (A) are not typically affected by lithium toxicity. Symptoms of infection (C) are unrelated to lithium toxicity. Monitoring temperature (D) is important but not specific to lithium toxicity.
After reviewing the discharge instructions with the family, which of the following statements by a parent indicate an understanding of the teaching? Click to specify if the statement reflects an understanding or indicates a need for reinforcement.
- A. We should notify the provider if the cast becomes loose over time.
- B. It is important that our child avoids placing anything inside the cast.
- C. We should prop the casted arm on pillows for the next 24 hours.
- D. We should expect the swelling and tingling to worsen before it gets better.
- E. We need to be very careful about how we handle the cast for the first 2 days while it dries.
Correct Answer: A,B,C,E
Rationale: Statements A, B, C, and E reflect correct understanding. Expecting worsening symptoms (D) requires clarification as it may indicate complications.
Which task should the nurse perform to practice distributive justice?
- A. Ensuring that a client who is homeless receives preventative medical care
- B. Allocating community resources fairly among all clients in need.
- C. Prioritizing care for clients based on medical necessity rather than financial status.
- D. Advocating for equal access to healthcare services for underserved populations.
- E. Developing programs that address social determinants of health to reduce disparities.
Correct Answer: E
Rationale: The correct answer is E because developing programs that address social determinants of health to reduce disparities aligns with the principle of distributive justice, which focuses on fair distribution of resources to reduce inequalities. By addressing social determinants of health, such as income inequality or access to education, the nurse is working towards creating equal opportunities for all individuals to achieve good health outcomes.
Choices A, B, C, and D do not directly address the root causes of health disparities and inequality. Option A focuses on providing care to a specific individual rather than addressing systemic issues. Option B talks about allocating resources fairly but lacks the focus on addressing social determinants. Option C mentions prioritizing care based on medical necessity, which may not necessarily target disparities. Option D discusses advocating for equal access, but it does not specifically address the underlying social determinants that contribute to inequalities.