Which of the following techniques involves the sense of sight?

Correct Answer: A

Rationale: The correct answer is Inspection (Choice A). Inspection is a technique that involves observing the patient using the sense of sight. During inspection, a healthcare provider visually examines the patient for any abnormalities, changes, or specific signs that may help in diagnosing a condition. Palpation (Choice B) involves using the sense of touch to feel for abnormalities, Percussion (Choice C) involves tapping the body to produce sounds that can help identify the underlying structures, and Auscultation (Choice D) involves listening to sounds produced by the body, typically using a stethoscope. Therefore, in this context, the technique that specifically involves the sense of sight is Inspection.

Correct Answer: B

Rationale: Maintaining the patient in an orthopneic position as needed is the most appropriate nursing order for a patient experiencing dyspnea and shortness of breath. This position helps to optimize lung expansion, improve oxygenation, and alleviate breathing difficulties. It is a strategic intervention to enhance respiratory function in patients with respiratory distress.

Correct Answer: A

Rationale: Orem's theory, also known as the Self-Care Deficit Nursing Theory, emphasizes individuals' ability to perform self-care to maintain health and well-being. One aspect of this theory is the maintenance of a sufficient intake of air, which is essential for sustaining life and overall health. This self-care component focuses on the individual's ability to meet their physiological needs, including the intake of air, to promote optimal functioning and health.

Correct Answer: A

Rationale: Back Care involves caring for the back through activities such as massage, exercises, proper posture, and ergonomic practices to maintain spinal health and prevent injuries. Massage helps relieve muscle tension, improve circulation, and promote relaxation, making it an effective method for back care.

Correct Answer: C

Rationale: The correct answer is the stomach. The stomach is a muscular organ located slightly to the left in the abdominal cavity. It serves as a temporary storage site for food where it is mixed with digestive enzymes and acids to begin the process of digestion.

Correct Answer: D

Rationale: In cases where the oral route is not recommended due to oral surgery or altered consciousness, the rectal method is preferred for the most accurate body temperature reading. This method is particularly useful when the skin is flushed and warm, as it provides a reliable reflection of core body temperature despite external factors affecting the skin temperature. Axillary temperature may not be as accurate, and arterial line temperature monitoring is invasive and not typically used for routine temperature assessment.

Correct Answer: D

Rationale: Alzheimer's disease is the most common cause of dementia among elderly persons. It is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. While Parkinson's disease, multiple sclerosis, and amyotrophic lateral sclerosis are serious conditions, they are not typically associated with dementia in the same way Alzheimer's disease is.

Correct Answer: B

Rationale: 1 cc (cubic centimeter) is equal to 1 ml. Therefore, 20 cc is equal to 20 ml. To convert between cubic centimeters (cc) and milliliters (ml), the values are equivalent, as they both measure volume in the metric system.

Correct Answer: B

Rationale: The nursing process is a systematic, rational method that guides nurses in planning and delivering patient care. It involves a series of steps including assessment, diagnosis, planning, implementation, and evaluation. By utilizing the nursing process, nurses can provide individualized care tailored to the specific needs of patients, families, groups, and communities.