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General Exams (Nursing Community) – Page 8

#141. A community health nurse is schedule to do home visit. She visits to an elderly person living alone. Which of the following observation would be a concern?
A Picture windows
B Unwashed dishes in the sink
C Brightly lit rooms
D Clear and shiny floors
Answer: Clear and shiny floors
#142. After a birth, the physician cut the cord of the baby, and before the baby is given to the mother, what would be the initial nursing action of the nurse?
A Examine the infant for any observable abnormalities
B confirm identification of the infant and apply bracelet to mother and infant
C Wrap the infant in a prewarmed blanket and cover the head
D Instill prophylactic medication in the infant’s eyes
Answer: Wrap the infant in a prewarmed blanket and cover the head
#143. A 2-year-old client is admitted to the hospital with severe eczema lesions on the scalp, face, neck and arms. The client is scratching the affected areas. What would be the best nursing intervention to prevent the client from scratching the affected areas?
A Mittens to the hands
B Clove-hitch restraints to the hands
C A posey jacket to the torso
D Elbow restraints to the arms
Answer: Mittens to the hands
#144. The parents of the hospitalized client ask the nurse how their baby might have gotten pyloric stenosis. The appropriate nursing response would be ____________________.
A Their baby acquired it due to a formula allergy
B Their baby developed this condition during the first few weeks of life
C Their baby was born with this condition
D There is no way to determine this preoperatively
Answer: Their baby developed this condition during the first few weeks of life
#145. A male client comes to the clinic for check-up. In doing a physical assessment, the nurse should report to the physician the most common symptom of gonorrhea, which is __________________.
A Pruritus
B Dysuria
C WBC in the urine
D Pus in the urine
Answer: Pus in the urine
#146. Which of the following would be the most important goal in the nursing care of an infant client with eczema?
A preventing infection
B providing for adequate nutrition
C Maintaining the comfort level
D Decreasing the itching
Answer: preventing infection
#147. The nurse is making a discharge instruction to a client receiving chemotherapy. The client is at risk for bone marrow depression. The nurse gives instructions to the client about how to prevent infection at home. Which of the following health teaching would be included?
A Get a weekly WBC count
B Do not share a bathroom with children or pregnant woman
C Do frequent hand washing and maintain good hygiene
D Avoid contact with others while receiving chemotherapy
Answer: Do frequent hand washing and maintain good hygiene
#148. The nurse is assigned to care the client with infectious disease. The best antimicrobial agent for the nurse to use in handwashing is ____________________.
A Isopropyl alcohol
B Chlorhexidine gluconate (CHG) (Hibiclens)
C Soap and water
D Hexachlorophene (Phisohex)
Answer: Chlorhexidine gluconate (CHG) (Hibiclens)
#149. The mother of the client tells the nurse, “ I’m not going to have my baby get any immunization”. What would be the best nursing response to the mother?
A You are needlessly placing other people at risk for communicable diseases
B Your baby will not be able to attend day care without immunizations
C You and I need to review your rationale for this decision”
D Your decision can be viewed as a form of child abuse and neglect
Answer: You and I need to review your rationale for this decision”
#150. The nurse is teaching the client about breast self-examination. Which observation should the client be taught to recognize when doing the examination for detection of breast cancer?
A Tender, movable lump
B Pain on breast self-examination
C Dimpling of the breast tissue
D round, well-defined lump
Answer: Dimpling of the breast tissue
#151. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be ________________l
A Maintain the patient in an orthopneic position as needed
B Administer oxygen by venturi mask at 24%, as needed
C Allow a 1 hour rest period between activities
D Maintain the patient on strict bed rest at all times
Answer: Maintain the patient in an orthopneic position as needed
#152. The hospitalized client diagnosed with end stage cancer suddenly wants to discontinue treatment including no antibiotics, tube feedings, and mechanical ventilation. When acting as the client's advocate, which priority action should be taken by the nurse?
A Respect the client's wishes and indicate those wishes on the plan of care
B Notify the client's HCP and have the client share the decision with the family.
C Withhold the treatments and clarify other treatments that the client wishes to withhold
D Decide what to do based on the client's condition when additional treatment needed
Answer: Notify the client's HCP and have the client share the decision with the family.
#153. The act of utilizing the environment of the patient to assist him in his recovery is theorized by ___________________.
A King
B Swanson
C Benner
D Nightingale
Answer: Nightingale
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