The home health nurse enters the home of a client, and the client's spouse immediately reports that the client cannot be awakened and appears to have taken an overdose of some medications. After determining that the client is unresponsive but is breathing and has a pulse, which action should the nurse take?

Call 911 for emergency transport.

Determine what medications were ingested.

Contact the poison control center.

Attempt to induce vomiting using a tongue blade.

Answer and Explanation

The Correct Answer is A

A) Call 911 for emergency transport:
The client is unresponsive, which is a critical situation requiring immediate medical attention. Even though the client is breathing and has a pulse, the unresponsiveness suggests a potentially severe overdose that could rapidly deteriorate. Calling 911 ensures that emergency medical services are on their way to provide advanced care and transport to a facility where further treatment can be administered.

B) Determine what medications were ingested:
While knowing what medications were taken is important for treatment, the immediate priority is to address the client’s unresponsiveness. Identifying the medications can be done once the client is stabilized or while awaiting emergency services, but it does not replace the need for urgent medical intervention.

C) Contact the poison control center:
Contacting the poison control center is useful for guidance on managing an overdose, but it should be done in conjunction with calling 911 if the client is unresponsive. The poison control center can provide specific treatment advice, but immediate emergency medical assistance is crucial for the client’s safety.

D) Attempt to induce vomiting using a tongue blade:
Inducing vomiting can be dangerous, especially if the client is unresponsive or has an impaired airway. Attempting to induce vomiting without professional medical support could lead to aspiration or other complications. The priority is to ensure the client receives proper medical care through emergency services.

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Correct Answer is A

Explanation

A) Fasting blood glucose average readings were 20% lower at the end of the classes:
This outcome measure directly evaluates the effectiveness of the diabetes education classes. A significant reduction in fasting blood glucose levels indicates that the classes had a positive impact on the clients' diabetes management, reflecting the practical success of the educational interventions.

B) Discussion of food exchanges and calories was a well-attended class:
While class attendance is a positive indicator of interest, it does not measure the actual effectiveness of the classes in improving diabetes management. Attendance alone does not confirm that the information was effectively applied or that it led to improved health outcomes.

C) Demonstrating the use of a blood glucose meter was an effective teaching strategy:
Although demonstrating the use of a blood glucose meter is an important teaching strategy, evaluating its effectiveness does not provide a comprehensive measure of the overall impact of the classes. The ultimate goal is to see improvements in health outcomes, such as blood glucose control.

D) Parking convenience for attendees continued to be a major concern:
While logistical issues like parking convenience are important for class accessibility, they do not reflect the effectiveness of the educational content in improving health outcomes. The focus should be on measurable changes in clients' health status, such as blood glucose levels.

A. Greens and beans. B. Meats and sweets. C. Fish on a dish. D. Berries or cherries.

Correct Answer is B

Explanation

A) Greens and beans:
While greens and beans are generally considered healthy foods, they are not the types of foods that should be limited in a Mediterranean-based diet. This option does not accurately reflect foods that should be restricted for heart health.

B) Meats and sweets:
This selection correctly identifies foods that should be limited in a Mediterranean-based eating approach. The Mediterranean diet emphasizes a lower intake of red meats and sweets, favoring healthier fats, whole grains, and vegetables. Thus, "meats and sweets" accurately represents the types of foods that should be consumed in moderation.

C) Fish on a dish:
Fish is a key component of the Mediterranean diet and is typically encouraged rather than limited. This option does not align with the goal of identifying foods to limit.

D) Berries or cherries:
Berries and cherries are nutrient-dense fruits that are encouraged in a Mediterranean-based diet rather than limited. This choice does not reflect the foods that should be restricted.

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Naxlex Comprehensive Predictor Exams

A nurse designs a series of four weekly classes for clients with type 2 diabetes mellitus. Which information should the nurse use as an outcome evaluation for the classes?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

A nurse is interested in studying the incidence of infant death in a particular city and wants to compare that city's rate to the state's rate. Which state resource should the nurse select to gather this information?

Which measure should the college health clinic nurse implement to reduce the incidence of meningococcal meningitis in college freshmen?

The community health nurse determines that the average family income of a certain community is $67,000 per year with a range of $27,000 to $102,000. Based on this demographic information, which additional information is important for the nurse to assess?

Community health nurses are particularly concerned with the spread of communicable diseases such as hepatitis A. Which group of Individuals should the nurse identify as being at greatest risk for contracting this type of hepatitis?

A 66-year-old client is retiring and will no longer have health insurance through a place of employment. Which agency should the client be referred to by the employee health nurse for health insurance needs?

Two years ago, the nurse assessed the health needs of high school students and determined that student pregnancy was a priority problem. The nurse then developed a pregnancy prevention program for the entire school district. Which finding is the best indicator of the program's effectiveness?

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago, and she has not yet received any medical care. She smokes but denies any other substance use. Which interventions should the nurse implement? (Select all that apply.)