Nursing Elites

1. A child and his family were exposed to Mycobacterium tuberculosis about 2 months ago. To confirm the presence or absence of an infection, it is most important for all family members to have a

• A. Chest x-ray
• B. Blood culture
• C. Sputum culture
• D. PPD intradermal test

Correct answer: D

Rationale: The PPD (purified protein derivative) intradermal test is the standard screening method for detecting tuberculosis infection. It helps identify individuals who have been infected with Mycobacterium tuberculosis. A chest x-ray (Choice A) is used to assess the extent of active disease, not for screening purposes. Blood culture (Choice B) is not typically used for tuberculosis screening. Sputum culture (Choice C) is used to confirm active tuberculosis in symptomatic individuals, not for initial screening purposes.

2. Following-up Mrs. Luy, G5P4, you notice her eldest son is underweight and her youngest daughter looks thin and pale. Mrs. Luy's present pregnancy would mean another additional member of the family. This can be considered as:

• A. health deficit
• B. health deficit and health threat
• C. health threat
• D. foreseeable crisis

Correct answer: C

Rationale: The correct answer is C: 'health threat.' The new pregnancy poses a health threat due to the potential strain on resources and the existing issues with the children, such as underweight and being pale. Choice A is incorrect as it does not fully capture the potential risks associated with the new pregnancy. Choice B is also incorrect as it includes 'health deficit,' which is not explicitly mentioned in the scenario. Choice D, 'foreseeable crisis,' is not the most fitting description of the situation presented.

3. The nurse is teaching a client about the healthy use of ego defense mechanisms. An appropriate goal for this client would be

• A. Reduce fear and protect self-esteem
• B. Minimize anxiety and delay apprehension
• C. Avoid conflict and leave unpleasant situations
• D. Increase independence and communicate more effectively

Correct answer: A

Rationale: The correct answer is A: 'Reduce fear and protect self-esteem.' When teaching a client about the healthy use of ego defense mechanisms, the goal is to help the individual manage emotions effectively without denying reality. Using defense mechanisms in a healthy way aims to reduce fear and protect self-esteem while still addressing underlying issues. Choices B, C, and D are incorrect because they do not focus on the core principles of using defense mechanisms in a healthy manner. Minimizing anxiety and delaying apprehension, avoiding conflict and leaving unpleasant situations, and increasing independence and communicating more effectively do not directly align with the goal of utilizing ego defense mechanisms in a constructive way.

4. A client with acute pancreatitis is experiencing severe abdominal pain. The nurse should implement which of the following interventions?

• A. Encourage oral intake
• B. Administer opioid analgesics
• C. Apply a heating pad to the abdomen
• D. Place the client in a supine position

Correct answer: B

Rationale: The correct intervention for a client with acute pancreatitis experiencing severe abdominal pain is to administer opioid analgesics. Opioids are effective in managing the severe pain associated with acute pancreatitis. Encouraging oral intake may exacerbate the symptoms and is contraindicated due to the need for bowel rest. Applying a heating pad to the abdomen can worsen inflammation and should be avoided. Placing the client in a supine position may not provide relief and could potentially lead to increased discomfort.

5. In providing comprehensive family health care, the nurse utilizes four (4) basic processes. These are listed in the order in which they are carried out as follows:

• A. assessment, planning, intervention, and evaluation
• B. assessment, intervention, planning, and evaluation
• C. planning, assessment, intervention, and evaluation
• D. planning, intervention, evaluation, and assessment

Correct answer: A

Rationale: The correct order for the basic processes in providing comprehensive family health care is assessment, planning, intervention, and evaluation. Assessment is the first step to gather information, followed by planning to set goals and strategies, then intervention to implement the plan, and finally evaluation to assess the outcomes. Choice A is correct as it follows this logical sequence. Choices B, C, and D are incorrect because they do not follow the correct order of these essential processes in nursing care.

Similar Questions