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| Section | Weight | Objectives |
|---|---|---|
| Safe and Effective Care Environment | 17–33% | - Management of Care - Safety and Infection Control |
| Health Promotion and Maintenance | 6–12% | |
| Physiological Integrity | 43–67% | - Basic Care and Comfort - Physiological Adaptation - Reduction of Risk Potential - Pharmacological and Parenteral Therapies |
| Psychosocial Integrity | 6–12% |
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NEW QUESTION # 672
A newborn has been delivered with a meningomyelocele. The nursery nurse should position the newborn:
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) The prone position reduces pressure and tension on the sac. Primary nursing goals are to prevent trauma and infection of the sac. (B) The supine position exerts pressure on the sac. (C) Newborns usually cannot maintain side-lying position. (D) The semi- Fowler position exerts pressure on the sac.
NEW QUESTION # 673
In admitting a client to the psychiatric unit, the nurse must explain the rules and regulations of the unit. A client with antisocial personality disorder makes the following remark, "Forget all those rules. I always get along well with the nurses." Which nursing response to him would be most effective?
Answer: B
Explanation:
(A) This answer is incorrect. A nurse should be an appropriate role model. Threats are not appropriate. No limit setting was stated. (B) This answer is correct. The nurse made a positive statement followed by a simple, clear, concise setting of limits. (C) This answer is incorrect. It appears to have a negative connotation. There was no limit setting. (D) This answer is incorrect. The nurse obviously responded in a negative manner. Learning takes place more readily when one is accepted, not rejected. No limits were set.
NEW QUESTION # 674
A mother who is breast-feeding her newborn asks the RN, "How can I express milk from my breasts manually?" The RN tells her that the correct method for manual milk expression includes using the thumb and the index finger to:
Answer: C
Explanation:
(A) Manipulation of nipples will cause soreness and trauma. (B) Pulling the nipples will cause discomfort and soreness. (C) Sliding the thumb and index finger forward over the nipple will cause soreness. (D) The best method to express milk from the breast is to position the thumb and index finger at the outer border of the areola and compress. This is the location of the milk sinuses.
NEW QUESTION # 675
The nurse is developing a plan of care for a client with an electrolyte imbalance and identifies a nursing diagnosis of decreased physical mobility. Which alteration is most likely the etiology?
Answer: D
Explanation:
Explanation
(A) A deficit in sodium concentration results in muscular weakness and lethargy. (B) Muscle fatigue and hypotonia are caused by hypercalcemia. (C) Muscle weakness and fatigue are classic signs of hypokalemia.
(D) Hypermagnesemia can cause muscle weakness, paralysis, and coma.
NEW QUESTION # 676
Clients receiving antipsychotic drug therapy will often exhibit extrapyramidal side effects that are reversible with which of the following agents ordered by the physician?
Answer: D
Explanation:
Explanation
(A) This answer is incorrect. Phenothiazines are antipsychotic drugs and produce the symptoms. (B) This answer is correct. Anticholinergic agents are often used prophylactically for extrapyramidal symptoms. They balance cholinergic activity in the basal ganglia of the brain. (C) This answer is incorrect. Anti- Parkinsonian drugs would increase the symptoms. (D) This answer is incorrect. Tricyclic agents are used for symptoms of depression.
NEW QUESTION # 677
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