A first-response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?

A client who has a rigid abdomen with manifestations of shock.

A client who has a femur fracture with a 2+ pedal pulse.

A client who is ambulatory and exhibits manic behavior.

A client who has superficial partial-thickness burn injuries over 5% of his body.

Answer and Explanation

The Correct Answer is A

The correct answer is Choice A because, a client who has a rigid abdomen with manifestations of shock. This client is showing signs of internal bleeding and hypovolemic shock, which is a medical emergency that requires immediate treatment to prevent further complications or death. Therefore, the priority should be given to this client.

Choice B is wrong because, a client who has a femur fracture with a 2+ pedal pulse, has a stable condition and can wait for treatment. Choice C is wrong because, a client who is ambulatory and exhibits manic behavior, is not a medical emergency and can wait for treatment. Choice D is wrong because, a client who has superficial partial-thickness burn injuries over 5% of his body, can wait for treatment as these injuries are not life-threatening.

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Correct Answer is A

Explanation

The correct answer is Choice A because, "I am obese because it's in my genes." The client is using rationalization as a coping mechanism by justifying their obesity as being predetermined by their genes, rather than acknowledging their personal responsibility in managing their weight. Rationalization is a defense mechanism in which a person gives a false or socially acceptable explanation for an unacceptable behavior or situation.

Choice B is wrong because, "I have difficulty resisting the items in vending machines," is not the correct answer because it is an excuse rather than a rationalization.

Choice C is wrong because, "I know you don't like me because I am obese," is not the correct answer because it is an example of projection, in which the client attributes their own feelings of dislike to others.

Choice D is wrong because, "I have lots of health problems from being obese," is not the correct answer because it is a justification, not a rationalization

A. Clients will start hormone replacement therapy. B. Clients will significantly decrease caloric intake. C. Clients will schedule bone density screenings. D. Clients will arrange for mammograms every 3 years.

Correct Answer is C

Explanation

The correct answer is Choice C because, "Clients will schedule bone density screenings." Postmenopausal women are at an increased risk for osteoporosis, and bone density screenings can help identify early signs of the disease, enabling early intervention to prevent complications.

Choice A is wrong because, "Clients will start hormone replacement therapy," is not the correct answer because hormone replacement therapy is not appropriate for all women and can have

negative side effects. It is not an appropriate outcome for an educational program.

Choice B is wrong because, "Clients will significantly decrease caloric intake," is not the correct answer because this outcome is not relevant to postmenopausal women specifically. Additionally, significant caloric restriction can lead to malnutrition and other negative health outcomes.

Choice D is wrong because, "Clients will arrange for mammograms every 3 years," is not the correct answer because while mammograms are an important screening tool for breast cancer, they are not specific to postmenopausal women and should be recommended to all women starting at age 40. Bone density screenings are a more appropriate outcome for a program specifically targeting postmenopausal women.

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A first-response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

Correct Answer is A

Explanation

A community health nurse is planning an educational program for a group of women who are postmenopausal. Which of the following outcomes is appropriate for this program?

Correct Answer is C

Explanation

A home health nurse is caring for a client who has chemotherapy-induced nausea that has been resistant to relief from pharmacological measures. Which of the following interventions should the nurse initiate? (Select all that apply.)

A nurse is working to reduce individual and family violence in the local community. Which of the following actions by the nurse demonstrates a primary prevention strategy to achieve this goal?

A faith community nurse is planning care for a client who has been diagnosed with end-stage breast cancer. Which of the following interventions should the nurse include in the plan?

A home health nurse is assessing a client who has AIDS. Which of the following responses by the client indicates a risk for suicide?

A school nurse is implementing health screenings. Which of the following assessment findings should the nurse recognize as the highest priority?

A home health nurse is performing a home safety evaluation for a newly admitted client. Which of the following findings requires action by the nurse? (Select all that apply.)

A hospice nurse is concerned that the partner of a client is experiencing caregiver burden. Which of the following actions should the nurse take first?

A home health nurse is visiting a client who has right-sided weakness following a recent stroke. The client states, "I'm not sure how I will buy my groceries since I can't go back to work." Which of the following actions should the nurse take?