Miami Dade College, Miami CTS CIS4617 Evolve nivel III Health Promotion and Maintenance

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Health Promotion and Maintenance 1.A client who is suspected of having tetanus asks a nurse about immunizations against tetanus. Before responding, what should the nurse consider about the benefits ... of tetanus antitoxin? It stimulates plasma cells directly. A high titer of antibodies is generated. It provides immediate active immunity. A long-lasting passive immunity is produced. Tetanus antitoxin provides antibodies, which confer immediate passive immunity. Antitoxin does not stimulate production of antibodies. It provides passive, not active, immunity. Passive immunity, by definition, is not long-lasting. 2.A nurse is determining whether a 5-year-old child is displaying appropriate behaviors for this age. What developmental findings does the nurse expect? Select all that apply. Enjoys imitative play Engages in ritualistic games Makes up rules for a new game Asks for a pacifier when uncomfortable Plays near others quietly but not with them Imitating adults by playing adult roles in society is at its peak in children 5 years of age; activities are strongly identified with same-sex parent. A 5-year-old is able to negotiate and use make-believe to play. These children are able to follow some rules but may cheat to win. Older children in the middle childhood years need conformity and rituals, whether they play games or amass collections. Rules to games are fixed, unvarying, and rigid. Knowing the rules means belonging. The use of a pacifier for oral satisfaction is typical of infants. Parallel play occurs in children ages 2 to 3 years. 3.What is the most appropriate communication strategy for the nurse working with adolescents in a clinic in a large city health center? Relating on a peer level Using typical teenage language Establishing a relationship over time Having discussions in concrete terms Several meetings with an adolescent provide an opportunity to develop trust and establish a relationship. Relating on a peer level is unrealistic because the nurse is not an adolescent’s peer. Using teenage language is not necessary and may even impede the establishment of a relationship. It is not necessary to use concrete terms, because the adolescent is capable of abstract thought.4.The nurse is examining different statements that represent the stages of psychosexual development, according to Sigmund Freud’s psychoanalytical model of personality development. Which statement indicates that the individual is aged between 6 to 12 years? The individual focuses on educational and social accomplishments. The individual tries to resolve prior sexual conflicts that have resurfaced. The individual realizes that the parent is something separate from the self. The individual fantasizes about the parent of the opposite sex as the first love interest. According to Sigmund Freud’s psychoanalytical model of personality development, an individual reaches the latency stage between 6 to 12 years of age. At this stage, the sexual urges of the oedipal stage are repressed and the individual channels them into socially acceptable productive activities. Therefore, the child focuses on educational and social accomplishments. When an individual reaches the genital stage, prior sexual conflicts resurface. He or she tries to resolve them in order to be able to begin an adult mature relationship. At the oral stage, which begins from birth and continues till 12 to 18 months, the infant is able to realize that the parent is something separate from the self. An individual between 3 to 6 years old is in the phallic or oedipal stage. At this stage, the child fantasizes about the parent of the opposite sex as the first love interest. Which of these features would the nurse state are exhibited by a preschooler? Temper tantrums Attempts to control situations Synchronization of moral skills Eagerness for formal education Learn to function independently Preschoolers refine the mastery of their bodies to function independently and eagerly await the beginning of formal education.When parents try to control the behavior of a toddler, it leads to temper tantrums and negative behavior. Toddlers get to know their abilities to control situations and seem pleased with it. School-aged children and adolescents refine and synchronize physical, psychosocial, cognitive, and moral skills to become accepted members of society. What important teaching strategies should the nurse take into consideration to bring a change in the client’s lifestyle? Select all that apply. Use written resources at an appropriate reading level. Practice active listening, and ask the client how he or she prefers to learn. Refrain from including family member in efforts to bring a change in the client’s lifestyle. Provide timelines for modification of eating and exercise lifestyle habits without consulting with the client.Start with identifying what information the client knows regarding health risks related to poor lifestyle choices. To bring a change in the client’s lifestyle, the nurse should use written resources at an appropriate reading level. The nurse should practice active listening and ask the client how he or she prefers to learn. The nurse should start by identifying what information the client knows regarding health risks related to poor lifestyle choices. The nurse should include family members to help bring changes in the client’s lifestyle. The nurse should provide timelines for modification of eating and exercise lifestyle habits after consulting with the client. 6.A parent expresses concern that the adolescent child is not ingesting enough calcium because of an allergy to milk. What alternative foods or liquids should the nurse suggest? Select all that apply. Cottage cheese Green leafy vegetables Black or baked beans Yogurt Oranges Salmon and sardines Green leafy vegetables, black and baked beans, oranges, and salmon and sardines are all good sources of calcium even though they do not contain milk or milk products. Cottage cheese and yogurt both contain milk and therefore must be eliminated. 9.A client asks a nurse about the most common problem associated with the use of an intrauterine device (IUD). What answer should the nurse provide? Perforation of the uterus Spontaneous device expulsion Discomfort associated with coitus Development of vaginal infections The IUD may cause irritability of the myometrium, inducing contraction of the uterus and expulsion of the device. Perforation of the uterus is a rare, rather than a common, occurrence. Clients do not report discomfort during coitus when an IUD is in place. Increased incidence of vaginal infections is not reported with the use of an IUD. 10.A couple interested in family planning asks the nurse about the cervical mucus method of family planning. The nurse explains that with this method the couple must avoid intercourse when and a few days after the cervical mucus is what? Clear and thick Yellow and thin Cloudy and viscid Clear and stretchableThe cervical mucus is clear and stretchable (spinnbarkeit) at ovulation because of maximal estrogen stimulation. Clear, thick cervical mucus occurs after ovulation has occurred. Yellow, thin cervical mucus does not occur at any specific point during the menstrual cycle and may indicate an infection. The parents of a school-age child tell the nurse, "My child seems very hot or red in the face, has abdominal pain, and appears jittery." What does the nurse suggest as the reason for the child’s signs and symptoms? "The child is experiencing stress in some area of life." "The child is growing up and feels the need for autonomy." "The child may be eating mostly junk food out of the house." "The child may be staying up late at night to watch television." Appearing hot or red in the face and jittery, along with abdominal pain, indicates that the child is experiencing stress. The parents need to talk about any stressors that the child is experiencing and should encourage the use of effective problem-solving and coping skills. Staying up late at night and watching television may cause fatigue, but not abdominal pain or jitteriness. The school-age child does not seek autonomy and shares most things with the family. Eating junk food out of the house may result in obesity or unhealthy eating habits. 2.What nursing intervention best meets a major developmental need of a newborn in the immediate postoperative period? Giving a pacifier to the infant Putting a mobile over the infant's crib Providing the infant with a soft, cuddly toy Warming the infant's formula before feeding Sucking meets oral needs, which are primary during infancy. An infant a few days old is too young to focus well on a mobile; in addition, the newborn will be placed in a side-lying position after surgery and therefore would not be able to see a mobile. A newborn is not developmentally capable of enjoying a soft, cuddly toy. Warming the infant's formula before feeding does not satisfy a developmental need. 3.A nurse is caring for a hospitalized school-aged child. What development-related activity is most important for the nurse to encourage? Family contact Peer interaction Therapeutic play Academic studies School-aged children have a need to be successful in school; this will help ensure that the child keeps up with the work being presented in class. Although contact with family is important, the school-aged child is beginning to move away from the family and into other realms. Although peer and social interactionsand play are important, industrious activities and educational success are more important at this age. The school-aged child does not benefit from therapeutic play as much as the preschooler does. At this age the child can understand a simple explanation of treatment, although it is helpful to be shown and to handle the equipment. 5.A student nurse compares the sources of stress in both 7-year-olds and 12-year-olds. Which source of stress is prevalent in children of both these age groups? Idols Health Money Confusion Idols are a source of stress for both 7-year-old and 12-year–old children. The 7-year-old has a desire to be more like an admired idol. The 12-year-old continues hero worshipping. Health is a source of stress for 12 year olds and some may become hypochondriacs during this period of development. Health is not a source of stress for 7 year olds. Money can be a source of stress for the 12 year old. This child is anxious to earn and handle money but often uses poor judgment. Money is not yet a matter of concern for the 7 year old. Too much freedom can create confusion in a 12-year-old and can cause the child to flounder. A 7-year-old does not usually have much freedom and, thereby, does not experience the accompanying stress. 7.A nurse in the women's health clinic is counseling clients about family planning. What should the nurse consider when discussing the effects of a high concentration of estrogen in the blood? It causes ovulation. Lactation is stimulated. It prompts secretion of oxytocin. It inhibits secretion of follicle-stimulating hormone (FSH). A high level of plasma estrogen inhibits anterior pituitary secretion of FSH; this effect appears to be mediated by the hypothalamus and its releasing factors. Luteinizing hormone, not estrogen, causes ovulation. Lactogenic hormone (prolactin) stimulates lactation. Putting the infant to the breast prompts the release of oxytocin, which is secreted by the posterior pituitary gland, resulting in the let-down reflex. 8.Which statements should the nurse include in a teaching session for pregnant couples regarding fetal growth and development? Select all that apply. "All major organs are developed and function prior to birth." "Development occurs in a head-to-toe and central-to-peripheral pattern." "The fetal stage of development is most vulnerable to teratogenic influences." "Pregnancy includes the preembryonic, embryonic, and fetal stages of development.""During pregnancy the embryo grows from a single cell to a complex physiologic being." Information the nurse should include in a teaching session regarding fetal growth and development during pregnancy includes that development occurs in a head-to-toe (cephalocaudal) and central-toperipheral (proximal-distal) pattern; the three stages of pregnancy include the preembryonic, embryonic, and fetal stages of development; and the embryo grows from a single cell to a complex physiologic being. While all major organs do develop during pregnancy not all function prior to birth. The embryonic, not the fetal, stage of development is most vulnerable to teratogenic influences. The client asks the nurse to recommend foods that might be included in a diet for diverticular disease. Which foods would be appropriate to include in the teaching plan? Select all that apply. Whole grains Cooked fruits and vegetables Nuts and seeds Lean red meats Milk and eggs With diverticular disease, the client should avoid foods that may obstruct the diverticuli. Therefore the fiber should be digestible, such as whole grains and cooked fruits and vegetables. Milk and eggs have no fiber content but are good sources of protein. For clients with diverticular disease, nuts and seeds are contraindicated, because they may be retained and cause inflammation and infection, which is known as diverticulitis. The client should also decrease intake of fats and red meats. 3.A nursing student is listing the steps that need to be followed for applying developmental theory when caring for chronically ill older adults with depression. Which step listed by the nursing student needs correction? "The nurse should understand adult development and its implications for practice." "The nurse should be aware of signs of depression such as general fatigue or insomnia." "The nurse should recognize the need to identify depression so that heart failure can be prevented." "The nurse should understand the older adult’s concept of depression and views on treatment for mental illness." The nurse should recognize the need to identify depression so that appropriate treatment can be provided to the older adults. Congestive heart failure is not caused by depression. The nurse should understand adult development and its implications for practice when applying developmental theory. The nurse should be aware of signs of depression such as general fatigue or insomnia. The nurse should understand the older adult’s concept of depression and views on treatment for mental illness as it helps him or her to get complementary and alternative treatment measures. 5.Because of a measles epidemic, a 6-month-old infant receives measles immunoglobulin. The nurse should help the parents understand that to ensure continuous protection against measles, the infant should be revaccinated around what age? 8 months 10 months12 months 18 months The optimal age for measles vaccination is between 12 and 15 months; if prophylaxis is given earlier because of exposure to a person with measles, it is not counted as one of the two required doses. Eight months and 10 months are too early; the infant will still have antibodies from the previous vaccination. Eighteen months is not the optimal time; the measles immunization should be given between 12 and 15 months. 7.During a routine physical examination a 10-year-old girl is discovered to have scoliosis. The curve is diagnosed as mild and functional, and a daily exercise program is established. The next month at the follow-up visit, what statement made by the girl helps the nurse determine that the child is complying with the exercise program? "I like doing my exercises with my brother so he can get stronger." "I think my exercises will make me a better softball and soccer player." "I do my exercises every day while my mother stays with me and watches." "I count out loud when I do my exercises so my mother can hear that I'm doing them all." The child is anticipating improvement; this reflects positive internal motivation, which helps maintain the child's interest and willingness to continue with the program. Motivation may diminish if the focus is on the brother rather than on the child's need to do the exercises. Doing the exercises to please the mother, as evidenced by having the mother watch every day or listen to the daughter counting to show that the exercises are being done, is external motivation, which is not as desirable as internal motivation. 10.The nurse instructs the son of an older client about age-related immune system changes and associated care measures. Which statement made by the son during a follow-up visit indicates a need for further instruction? "My parent has a private room at home." "My parent has received the pneumococcal vaccination recently." "My parent comes in for check-ups only whenever he or she has a fever." "My parent has been given a second dose of the pertussis vaccination." Older clients should have regular check-ups even in the absence of fever. Because aging causes reduced neutrophil function, some infections may not show fever symptoms. Older adults should have a private room at home to avoid other adults who may have viral infections. Because older adults have a decreased production of antibodies against new antigens, the caretaker should ensure that the older client has received updated vaccinations against infectious diseases such as pneumococcus and pertussis What is the similarity between the formal operations period and the preoperational period according to Piaget’s theory? Both the periods describe "imaginary audience." Both the periods demonstrate "animism" in a child.Both the periods explain egocentric thought of an individual. Both the periods occur in the beginning of cognitive development. The preoperational period and formal operations period explain the egocentric thought. The preoperational period describes "egocentrism" in a child at the age of 2 to 7 years; the formal operations period explains the egocentric thought from 11 years of age to adulthood. During the formal operations period, an individual believes that his/her actions and appearance are constantly being scrutinized by an "imaginary audience," which is not seen during the preoperational period. The preoperational period, not the formal operations period, tells about "animism" where the child thinks that there is life in every inanimate object. The preoperational period marks the beginning of the cognitive development, whereas formal operations period marks the end of cognitive development. 4.Which fine motor skill lacking in a 6-month-old infant would cause the nurse concern? Lack of a pincer grasp Inability to hold a bottle Lack of a hand preference Inability to pick up small objects The nurse would anticipate that a 6-month-old infant would be able to hold a bottle; therefore, this would cause the nurse concern. Lack of a pincer grasp, lack of hand preference, and the inability to pick up small objects would not cause the nurse concern at this time. 6.What is the similarity between evidence-based practice (EBP) and quality improvement (QI)? Both receive funding from internal sources. Both use data sources from multiple research studies. Both need approval of the institutional review board. Both are conducted by researchers employed for this purpose. Both evidence-based practice (EBP) and quality improvement (QI) are funded by internal sources. EBP uses information from multiple research studies; in contrast, QI collects data from client records. EBP does not require the institutional review board approval; QI sometimes may require institutional review board approval. EBP and QI are carried out by practicing nurses and possibly other members of the healthcare team. Research studies are carried out by researchers. 8.A school nurse is screening children for scoliosis. In what age group is it usually identified? Adolescence Preadolescence Early school years Middle school years Preadolescence is the time when scoliosis is most likely to become evident because of the growth spurt that occurs at this time. Although scoliosis may occur at any age, idiopathic scoliosis, the most common type, tends to become evident during the preadolescent growth spurt.9.A young child presents with a blood lead level (BLL) of 17 mcg/dL. The nurse is aware that the client’s BLL levels have remained at this level in two samples obtained 4 months apart. Which actions will the nurse take to provide appropriate care for this client? Select all that apply. Refer client to social services. Refer client to a clinical center specializing in lead poisoning. Consider treating with appropriate chelation therapy. Perform follow-up testing within 1 month, then every 3 to 4 months. Immediately provide diagnostic testing and initiate chelation therapy. The Centers for Disease Control and Prevention (CDC) have recommended various actions to be taken depending on the BLL of the client. While a BLL of 17 mcg/dL falls in the range of BLL 15-19 mcg/dL, the nurse needs to follow the guidelines for 20 to 44 mcg/dL if BLL remains 15 mcg/dL or higher on two samples obtained at least 3 months apart. The client in this case has had a BLL of 17 mcg/dL on two samples obtained 4 months apart, so, based on the guidelines for 20 to 44 mcg/dL, the nurse will refer the client to a clinical center specializing in lead poisoning and will also consider treating him or her with appropriate chelation therapy. The nurse would have simply referred the client to social services and performed follow-up testing within 1 month, then every 3 to 4 months, if the guidelines for BLL 15-19 mcg/dL had been followed. The nurse would immediately provide diagnostic testing and initiate chelation therapy if BLL is 70 mcg/dL or higher. 1.An infant born with exstrophy of the bladder is admitted to the pediatric unit for urinary diversion surgery in which the ureters are to be transplanted to a resected section of the small intestines, with one end attached to the abdominal wall. What does the nurse call the procedure when explaining the surgery to the parents? Cystostomy Ileal conduit Ureterosigmoidostomy Cutaneous ureterostomy An ileal conduit is the transplantation of the ureters into a resected portion of the ileum, which is then used to create a stoma on the abdominal wall for drainage of urine. Cystostomy is an opening into the bladder through the abdominal wall that allows urine to flow out. In ureterosigmoidostomy the ureter is transplanted into the colon and urine is excreted through the rectum. In cutaneous ureterostomy the ureter is transplanted through the abdomen and attached to the skin. 4.A nurse manager notices that a previously effective nurse appears to be distracted, at times forgets to document changes in clients’ status, and rarely completes the required workload without help from another nurse. What should the nurse manager say to the nurse? "You seem to be having difficulty completing your assignments. What can I do to help?" "Why are you having trouble fulfilling your assignment? I need to know what’s going on." "Call me to help you organize your day—then you’ll have time to complete your assignment.""I’ve noticed that you always give part of your workload to another nurse. This is unacceptable." An understanding and supportive approach to a colleague helps the individual identify and address the problem. Asking why the nurse is having trouble fulfilling her assignment and what is going on is an accusatory approach. Implying a lack of organizational skills may or may not be accurate; also, it is an accusatory approach. Observing that the nurse always gives part of her workload to another nurse and noting that this is unacceptable states a fact of which the individual is probably aware; it may interfere with self-identification of the problem and is accusatory. What are the similarities between evidence-based practice and quality improvement? Select all that apply [Show More]

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