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1. A nurse is caring for an 8-month-old infant who screams when the parent leaves the room. The parent begins to cry and says, 'I don't understand why my child is so upset. I've never seen my child act this way around others before.' Which of the following statements should the nurse make?
- A. This is a normal, expected reaction for a child of this age.
- B. This is a response to an overstimulating environment.
- C. This is a common reaction to an overexposure to caregivers.
- D. This is a typical reaction for a child who is sick.
Correct answer: A
Rationale: The correct answer is 'This is a normal, expected reaction for a child of this age.' Separation anxiety typically peaks around 8-10 months of age, leading to distress when separated from caregivers. Choice B is incorrect because the infant's behavior is more likely due to separation anxiety rather than overstimulation. Choice C is incorrect as the infant's behavior is not related to overexposure to caregivers but rather a natural developmental stage. Choice D is incorrect as the infant's behavior is not indicative of illness but rather a normal emotional response.
2. What is the purpose of a chest tube after a lobectomy procedure, as understood by the nurse?
- A. Prevent mediastinal shift
- B. Promote chest expansion of the remaining lung
- C. Drain fluids and blood accumulated post-operatively
- D. Remove the air in the lungs to promote lung expansion
Correct answer: C
Rationale: After a lobectomy, a chest tube is typically inserted to drain fluids and blood that may have accumulated post-operatively. This tube helps to prevent complications, such as infections or pneumonia, and aids in patient recovery. While a chest tube may aid in preventing a mediastinal shift (Choice A), promoting chest expansion of the remaining lung (Choice B), and removing air in the lungs to promote lung expansion (Choice D), these are not the primary reasons for its use after a lobectomy. Therefore, Choices A, B, and D are incorrect.
3. Mrs. Pichay who is for thoracentesis is assigned by the nurse to any of the following positions, EXCEPT:
- A. straddling a chair with arms and head resting on the back of the chair
- B. lying on the unaffected side with the bed elevated 30-40 degrees
- C. lying prone with the head of the bed lowered 15-30 degrees
- D. sitting on the edge of the bed with her feet supported and arms and head on a padded overhead table
Correct answer: D
Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.
4. Approximately 75% of reputable producers of bottled water use groundwater as their water source. Plain tap water is the most natural source of fluids.
- 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. Approximately 75% of reputable producers of bottled water use groundwater as their water source, which is the same source as the public water supply. Plain tap water, coming from underground sources or reservoirs, is indeed a natural source of fluids. The first statement is supported by the fact that groundwater is a common source for bottled water due to its purity and taste. The second statement is true as tap water is sourced from natural reservoirs or underground aquifers in most cases, making it a natural fluid source for consumption. Other choices are incorrect because both statements are factually accurate based on common practices in the production and sourcing of bottled water and tap water.
5. The mechanism behind most CKD in patients without diabetes is mediated by:
- A. enzyme systems
- B. immune systems
- C. catabolic systems
- D. hormonal systems
Correct answer: B
Rationale: In non-diabetic patients, CKD is often mediated by immune system responses. Chronic inflammation triggered by immune system dysfunction can contribute to progressive kidney damage. Therefore, the correct answer is 'immune systems.' Choices A, C, and D are incorrect because CKD in non-diabetic patients is primarily associated with immune system abnormalities rather than enzyme, catabolic, or hormonal systems.
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