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Free NCLEX-PN Exam Braindumps (page: 22)

Page 22 of 254
PDF with 1015 Questions

A paraplegic client is in the hospital to be treated for an electrolyte imbalance. Which level of care is the client currently receiving?

  1. primary prevention
  2. secondary prevention
  3. tertiary prevention
  4. health promotion

Answer(s): B

Explanation:

This client is receiving secondary prevention. The current focus of health care is on preventive care. Leavell and Clark (1965) described the three levels of preventive care as primary, secondary, and tertiary.
Secondary preventive care focuses on early detection of disease, prompt intervention, and health maintenance for clients experiencing health problems. Examples of activities at this level are carrying out direct nursing actions (for example, providing wound care, giving medications, exercising arms and legs), assessing children for normal growth and development, and encouraging regular medical and dental screenings and care.
Primary preventive care is directed toward health promotion and specific protections against illness. Activities at this level might focus on individuals or groups. Examples of primary-level activities are immunizations, family- planning services, teaching breast self-examination, poison-control information, and accident-prevention education.
Tertiary preventive care begins after an illness is diagnosed and treated and is aimed at helping rehabilitate clients and restore them to their maximum level of functioning.



Which of the following developmental milestones for a 6-month-old child should be screened by the nurse during a routine office visit?

  1. standing while holding something
  2. rolling over
  3. sitting up
  4. creeping

Answer(s): B

Explanation:

Rolling over occurs between 4 and 6 months of age. Sitting up occurs between 7 and 8 months, creeping between 9 and 10 months, and standing between 8 and 10 months.



During the health screening of an adolescent, which finding by the nurse requires further teaching?

  1. The client started her first menses 2 years ago.
  2. The client states she is currently on birth control pills.
  3. The client states she recently lost 5 pounds.
  4. The client states she is experiencing growing pains.

Answer(s): B

Explanation:

Because the client is on the pill, she requires further teaching regarding protection against STDs. The other findings are not abnormal for an adolescent.



A mother brings her 1-year-old child to the clinic. The child has no record of previous immunizations, and the mother confirms the child has not been immunized.

Which of the following should include teaching by the nurse?

  1. Immunizations may be started at any age.
  2. The recommended immunization schedule must be followed exactly.
  3. If a primary series of immunizations is interrupted, the series must be restarted.
  4. This child is at increased risk for reaction to the vaccines, when they are started.

Answer(s): A

Explanation:

While a recommended immunization schedule exists, immunizations may be started at any age. An interrupted series may be continued and need not be restarted.
There is no increased risk for reaction to vaccines due to delay.






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