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1. A nurse is providing teaching to a client with gastroesophageal reflux. Which of the following statements by the client indicates a need for further teaching?
- A. I should elevate the head of my bed while sleeping.
- B. I drink no more than 4 cups of coffee a day.
- C. I take my time when I am eating.
- D. I avoid foods and drinks made with chocolate.
Correct answer: B
Rationale: The correct answer is B: 'I drink no more than 4 cups of coffee a day.' Excessive coffee consumption can aggravate gastroesophageal reflux due to its acidic nature. Choices A, C, and D are all appropriate self-care measures for managing gastroesophageal reflux. Elevating the head of the bed while sleeping helps prevent acid reflux, eating slowly can reduce reflux episodes, and avoiding trigger foods like chocolate can help alleviate symptoms.
2. What happens when Mrs. Guevarra, a nurse, delegates aspects of the client's care to the nurse-aide, an unlicensed staff member?
- A. Mrs. Guevarra makes the assignment to instruct the staff member
- B. Mrs. Guevarra is assigning the responsibility to the aide but not the accountability for those tasks
- C. Mrs. Guevarra does not need to directly supervise or evaluate the aide
- D. Mrs. Guevarra must know how to perform the task being delegated
Correct answer: C
Rationale: The correct answer is C. While it is true that Mrs. Guevarra is delegating tasks to the nurse-aide, she does not necessarily have to directly supervise or evaluate the aide. She still retains the overall accountability for the care of the client, but direct supervision of the aide is not a requirement for delegation. Choice A is incorrect because the primary purpose of delegation is not instruction. Choice B is also incorrect because although Mrs. Guevarra is delegating tasks, she still retains accountability for those tasks. Finally, choice D is incorrect because the ability to perform the task being delegated is not a requirement for the delegator; the delegatee should have the necessary skills and knowledge to perform the delegated tasks.
3. Which of the following foods provides the most protein?
- A. Beans
- B. Red peppers
- C. Asparagus
- D. Celery
Correct answer: A
Rationale: The correct answer is 'Beans.' Beans are a rich source of plant-based protein, making them the best option among the listed foods for protein content. Red peppers, asparagus, and celery are not significant sources of protein compared to beans, hence they are incorrect choices for this question.
4. During early tooth development, vitamin A deficiency leads to enamel hypoplasia and defective dentin formation. Because of its effect on soft tissues and bone, vitamin A contributes to normal spacing of teeth.
- A. Both statements are true.
- B. Both statements are false.
- C. The first statement is true; the second is false.
- D. The first statement is false; the second is true.
Correct answer: A
Rationale: Both statements are true. The effect of vitamin A on the growth of soft tissues and bones naturally extends to the teeth and surrounding structures. Enamel hypoplasia, involving defective enamel matrix and incomplete calcification of enamel and dentin, can be due to vitamin A deficiency. The effect of this vitamin upon surrounding bone directly affects spacing patterns of the teeth within the bone and dentition. Choice A is correct because both statements accurately describe the influence of vitamin A on tooth development. Choices B, C, and D are incorrect as they do not reflect the accuracy of the statements provided.
5. Which topical antimicrobial is most frequently used in burn wound care?
- A. Neosporin
- B. Silver nitrate
- C. Silver sulfadiazine
- D. Sulfamylon
Correct answer: C
Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.
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