What type of assessment occurs in emergency situations?

Correct Answer: D

Rationale: In emergency situations, time is crucial. Emergency assessment is the most appropriate as it focuses on quickly identifying and addressing life-threatening issues. It involves a rapid but systematic evaluation of the patient's airway, breathing, circulation, and disability. Head-to-toe assessment (A) and comprehensive assessment (C) are too time-consuming in emergencies, whereas focused assessment (B) may not cover all critical aspects.

Correct Answer: A

Rationale: The correct answer is A: Administer bronchodilators. When a client with asthma develops wheezing, the primary action is to administer bronchodilators to help dilate the airways and improve breathing. This helps relieve the symptoms of wheezing and prevent further complications. Providing pain relief (Choice B) is not the primary action for wheezing in asthma. Encouraging deep breathing (Choice C) may worsen the wheezing in an asthma attack. Performing chest physiotherapy (Choice D) is not the first-line treatment for wheezing in asthma.

Correct Answer: A

Rationale: The correct answer is A: Administer glucose. The nurse's first action in treating hypoglycemia is to increase the client's blood glucose levels to prevent further complications. Administering glucose helps quickly raise blood sugar levels, addressing the immediate issue. Options B, C, and D are incorrect as administering insulin would further decrease blood sugar levels, administering oxygen is not the primary intervention for hypoglycemia, and administering antipyretics is used for reducing fever, not treating hypoglycemia.

Correct Answer: B

Rationale: Mammography is used to detect tumors in the breast tissue. It is a screening tool for breast cancer. Tumors can be either benign or malignant. Mammograms help in early detection of abnormalities in breast tissue. Pain, edema, and epilepsy are unrelated to the purpose of mammography. Pain is a symptom, edema is swelling, and epilepsy is a neurological disorder. Therefore, the correct answer is B because mammography is specifically designed to detect tumors in the breast.

Correct Answer: B

Rationale: The correct action for a client with DVT in the leg is to apply compression and elevate the leg (Choice B). Compression helps prevent blood clots from moving and causing further complications. Elevating the leg reduces swelling and improves blood flow. Choice A is incorrect because applying heat can actually worsen DVT by promoting inflammation and increasing blood flow. Choice C is incorrect as massage can dislodge blood clots and lead to serious complications like pulmonary embolism. Choice D is incorrect as massaging the leg can be dangerous in DVT as mentioned before.

Correct Answer: A

Rationale: The correct answer is A: Administer antiepileptic drugs. This is the most important nursing action for a client with a history of seizures because antiepileptic drugs help prevent or reduce the frequency and severity of seizures. By ensuring the client receives their prescribed medication, the nurse can help manage the condition effectively. Placing the client on their side (B) is important to prevent aspiration if a seizure occurs, but administering antiepileptic drugs is more crucial for long-term management. Checking the airway (C) is important during and after a seizure but does not address the underlying cause. Monitoring for hypoglycemia (D) is important as a potential trigger for seizures, but administering antiepileptic drugs takes precedence in managing the condition.

Correct Answer: A

Rationale: The correct answer is A, contusion. A contusion is a soft-tissue injury caused by blunt force resulting in bruising, without breaking the skin. This is different from the other choices. Strain (B) refers to an injury to a muscle or tendon due to overstretching. Sprain (C) is an injury to a ligament from overstretching. Dislocation (D) involves the displacement of bones at a joint, not a soft-tissue injury. Therefore, the term that specifically aligns with a soft-tissue injury from blunt force is contusion.

Correct Answer: D

Rationale: A focused assessment is more in-depth on specific issues, providing detailed information on a particular problem or concern. This allows for targeted interventions and treatment strategies. In contrast, a comprehensive assessment covers the body head to toe and involves all body systems, which may not be necessary when focusing on a specific issue. Occurring only in the clinic is a limitation to choice B, as assessments can be conducted in various settings. Involving all body systems, as stated in choice C, is not the primary focus of a focused assessment.

Correct Answer: D

Rationale: Step-by-step rationale for why answer D is correct: 1. Empathy and respect: By saying "I respect your decision to choose surgery," you acknowledge her autonomy and decision-making. 2. Supportive approach: This response shows understanding and non-judgmental support for her choice. 3. Person-centered care: Recognizing her individual needs and choices is crucial in providing quality healthcare. Summary: A: Irrelevant and insensitive to her medical needs. B: Disregards her current situation and overlooks the complexity of weight loss. C: Implies a one-size-fits-all approach without considering her specific circumstances. D: Demonstrates respect, understanding, and support for her decision-making.