One of the highest priorities of nursing care is:
maintaining skin integrity
adequate nutrition
pain control
airway management
The Correct Answer is D
A. Maintaining skin integrity:
Maintaining skin integrity is crucial for preventing pressure ulcers and other skin-related issues, especially for patients who are bedridden or have limited mobility. Preventive measures, like turning the patient regularly and keeping the skin clean and dry, are essential. While important, it is not always the highest priority and can be managed alongside other nursing interventions.
B. Adequate nutrition:
Providing adequate nutrition is vital for the patient's overall health and recovery. Malnutrition can impair the healing process and weaken the immune system. However, in immediate critical situations, addressing the airway, breathing, and circulation (ABCs) takes precedence over nutritional concerns. Once the patient is stable, addressing nutrition becomes a priority in the nursing care plan.
C. Pain control:
Managing pain is crucial for a patient's comfort and well-being. Uncontrolled pain can cause anxiety, impair healing, and decrease the overall quality of life. Pain control is a high priority, but in certain emergencies where the patient's airway or circulation is compromised, managing pain might be temporarily secondary until the primary issues are addressed.
D. Airway management:
Ensuring a clear airway is often the highest priority in emergency situations. Without a patent airway, the patient cannot breathe effectively, leading to oxygen deprivation and potential cardiac arrest. Nurses and healthcare providers focus on maintaining or establishing a clear airway to ensure the patient can breathe adequately. Once the airway is secured, attention can be directed to other aspects of care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["4"]
Explanation
To calculate the number of 40mg capsules needed for a 2-grain dose, you need to convert grains to milligrams since the supply is given in milligrams (mg).
1 grain is approximately equal to 64.8 milligrams.
Now, let's calculate:
2 grains * 64.8 mg/grain = 129.6 mg
So, the nurse would give 129.6 milligrams of the medication. Since the supply is in 40mg capsules, you'll need to divide the total dose by the amount in each capsule to determine the number of capsules needed:
129.6 mg / 40 mg/capsule ≈ 3.24
Since you can't give a fraction of a capsule, the nurse would give 4 capsules to achieve a dose of approximately 129.6 milligrams.
Correct Answer is D
Explanation
A. Closed Body Posture:
Active listening often involves open body language, where the listener appears receptive and engaged. Closed body posture, where arms are crossed and body faces away, can indicate disinterest or disagreement, which is not a characteristic of active listening.
B. Three Senses - Sight, Hearing, and Touch:
Active listening primarily involves the sense of hearing. While non-verbal cues like facial expressions and body language are important, active listening doesn't necessarily include touch or sight as direct senses employed during the process.
C. Only Verbal Messages:
Active listening involves not only hearing the words spoken but also understanding the emotions, intentions, and concerns behind those words. It includes interpreting verbal and non-verbal cues, making it more than just processing verbal messages.
D. Focused Energy:
Active listening does require focused energy. It means being mentally present, concentrating on the speaker, and showing genuine interest in what they are saying. This focus allows the listener to comprehend the message and respond appropriately.
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