a nurse is caring for a client who has bilateral eye patches in place following an injury when the clients food tray arrives which of the following in
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1. A client has bilateral eye patches in place following an injury. When the client's food tray arrives, which of the following interventions should the nurse take to promote independence in eating?

Correct answer: C

Rationale: When a client has bilateral eye patches, promoting independence in eating is crucial to maintain dignity and autonomy. Describing the location of the food on the tray enables the client to locate and feed themselves. Assigning assistive personnel to feed the client (Choice A) takes away their independence. Merely informing the client that the tray is here and guiding their hands to it (Choice B) does not empower the client to eat independently. Asking if the client prefers a liquid diet (Choice D) is not directly addressing the client's ability to independently eat the current meal.

2. Risk factors that have been shown to contribute to age-related macular degeneration include _____.

Correct answer: A

Rationale: The correct answer is A: oxidative stress from sunlight. Oxidative stress caused by exposure to sunlight is a significant risk factor for age-related macular degeneration. This condition can result in vision loss among older individuals. Choices B, C, and D are incorrect. Iron-deficiency anemia, decreased intake of phytochemicals, and vitamin B6 malabsorption are not established risk factors for age-related macular degeneration.

3. Ms. Maria Salvacion says that she is the incarnation of the holy Virgin Mary. She said that she is the child of the covenant that would save this world from the evil forces of Satan. One morning, while caring for her, she stood in front of you and said “Bow down before me! I am the holy mother of Christ! I am the blessed Virgin Mary!” The best response by the Nurse is:

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

4. Does alcohol contain energy and is therefore a nutrient?

Correct answer: B

Rationale: Alcohol does contain energy and provides calories, but it is not considered a nutrient. Nutrients are substances that contribute to essential bodily functions. While alcohol may have energy, it does not provide essential vitamins, minerals, or other nutrients necessary for the body's health. Additionally, excessive alcohol consumption can have harmful effects on the body, further supporting why alcohol is not classified as a nutrient.

5. What are sheets/forms that provide an efficient and time-saving way to record information that must be obtained repeatedly at regular and/or short intervals of time? This does not replace progress notes; instead, it records information on vital signs, intake and output, treatment, postoperative care, postpartum care, and diabetic regimen, etc. These are used whenever specific measurements or observations need to be documented repeatedly. What is this?

Correct answer: A

Rationale: The correct answer is A, Nursing Kardex. Nursing Kardex is a tool used for documenting essential patient information that needs to be recorded repeatedly at regular intervals. It includes vital signs, intake and output, treatment details, postoperative care, postpartum care, and diabetic regimen. This tool is efficient and time-saving for healthcare professionals. Choice B, Graphic Flow Sheets, may be used for visual representation of patient data but is not specifically designed for repeated documentation of essential information. Choice C, Discharge Summary, is a document outlining the patient's care and condition at the time of discharge, not for repeated recording of ongoing data. Choice D, Medicine and Treatment Record, focuses more on specific medications and treatments rather than a comprehensive recording of various patient data needed at regular intervals.

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