At which stage of Lewin ' s planned change indicates the nurse identifying, planning, and implementing appropriate strategies ensuring that driving forces exceed restraining forces?

Correct Answer: C

Rationale: The correct answer is C: unfreezing. Unfreezing is the initial stage in Lewin's planned change model where individuals become open to change by recognizing the need for it. During this stage, the nurse identifies the need for change, plans strategies to implement it, and works on overcoming resistance by ensuring that the driving forces (reasons for change) outweigh the restraining forces (barriers to change). Refreezing (A) is the final stage where the changes are reinforced and integrated into the organization. Movement (B) is the stage where actual change occurs, and in activism (D) is not a recognized stage in Lewin's model.

Correct Answer: C

Rationale: The correct answer is C, to have a limited intake of sodium. Lithium can lead to increased sodium levels in the body, potentially causing toxicity. By limiting sodium intake, the patient can maintain a balance and prevent adverse effects. Choice A is incorrect as tyramine content is not directly related to lithium intake. Choice B is incorrect as fluid intake does not have a significant impact on lithium levels. Choice D is incorrect because an adequate intake of sodium can lead to worsening lithium toxicity.

Correct Answer: A

Rationale: The correct answer is A: Myasthenia gravis. In myasthenia gravis, there is a decrease in acetylcholine receptors at the neuromuscular junction, leading to muscle weakness and fatigue. This occurs due to autoimmune destruction of these receptors. ALS (B) affects motor neurons, not acetylcholine receptors. Guillain-Barre syndrome (C) is an autoimmune disorder affecting peripheral nerves, not neuromuscular junctions. Muscular dystrophy (D) is a genetic disorder causing muscle degeneration, not affecting acetylcholine receptors.

Correct Answer: B

Rationale: The correct answer is B: Acute glomerulonephritis. Glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to symptoms like hematuria (blood in urine), proteinuria (excess protein in urine), and hypertension (high blood pressure). Acute tubular necrosis (A) involves damage to the renal tubules, not the glomeruli. Chronic kidney disease (C) refers to long-term kidney damage and may not always present with the classic symptoms mentioned. Nephrotic syndrome (D) involves excessive protein loss in urine but may not always involve inflammation of the glomeruli.

Correct Answer: A

Rationale: The correct answer is A because obtaining the client's own consent is the first step in ensuring the client's autonomy and right to make decisions about their own care. This is in line with ethical principles of informed consent. Choices B, C, and D are incorrect because consent should come directly from the client, not from a spouse, family member, or social worker. Choice B violates the principle of individual autonomy, choice C is not the priority before admission, and choice D is not the appropriate person to provide consent.

Correct Answer: A

Rationale: The correct answer is A: Implement environmental modifications to promote sleep hygiene. Delirium is often triggered by environmental factors like noise, light, and disruption of sleep. By optimizing the environment for rest and minimizing stimuli, the patient's delirium can improve. This approach focuses on addressing the root cause rather than just managing symptoms. Choice B is incorrect because antipsychotic medications can worsen delirium and are not recommended as first-line treatment. Choice C is not the priority as ruling out focal deficits may be important but does not directly address the delirium. Choice D is incorrect as benzodiazepines can exacerbate delirium and are not recommended due to their potential to worsen cognitive function.

Correct Answer: B

Rationale: The correct answer is B: Cleanse the bite with soap and running water. This is the first nursing intervention because it is crucial to prevent infection. Cleaning the bite area helps remove bacteria and debris, reducing the risk of infection. Injecting with rabies immune globulin (choice A) and rabies vaccine (choice C) should be done later as per protocol after assessing the situation. Administering pain reliever (choice D) is important but not the first priority in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Diabetes insipidus. This condition is characterized by excessive thirst, large volumes of dilute urine, low urine osmolality, hypernatremia, and elevated serum osmolality. The underlying cause is a deficiency in or insensitivity to antidiuretic hormone (ADH), leading to the inability of the kidneys to concentrate urine properly. Hyperthyroidism (choice A) and hypothyroidism (choice B) do not directly affect urine concentration. While diabetes mellitus (choice C) can also present with polyuria and polydipsia, it would typically have high urine osmolality due to the presence of glucose. Therefore, diabetes insipidus is the most likely endocrine disorder responsible for these specific symptoms.

Correct Answer: C

Rationale: The correct answer is C: Food and water. Typhoid fever is primarily transmitted through contaminated food and water by the bacterium Salmonella typhi. The bacteria are shed in the feces of infected individuals and can contaminate water sources or food prepared with contaminated water. This transmission route aligns with the typical epidemiology of typhoid fever outbreaks. Now, let's discuss why the other choices are incorrect: A: A vector - Typhoid fever is not transmitted by a vector such as mosquitoes or ticks. B: Blood and body fluids - Typhoid fever is not typically spread through blood or body fluids but rather through ingestion of contaminated food or water. D: Air - Typhoid fever is not an airborne disease and is not transmitted through the air.