Evolve_nivel_III.docxHealth 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
...
Evolve_nivel_III.docxHealth 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.
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