a newborn presents with a pronounced cephalic hematoma following a birth in the posterior position which nursing diagnosis should guide the plan of ca
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Nursing Elites

HESI LPN

Community Health HESI Test Bank 2023

1. A newborn presents with a pronounced cephalic hematoma following a birth in the posterior position. Which nursing diagnosis should guide the plan of care?

Correct answer: C

Rationale: The correct nursing diagnosis to guide the plan of care for a newborn with a pronounced cephalic hematoma following a birth in the posterior position is 'Parental anxiety related to knowledge deficit.' This is appropriate because the parents may be worried about the appearance and potential complications of the cephalic hematoma. They may require education and reassurance from the nurse. Choices A, B, and D are incorrect because they do not address the emotional needs of the parents and the knowledge deficit they may have regarding the condition.

2. Manny Pacquiao, a Filipino and world boxing champion, used to advertise a muscle pain-relieving drug popularly known in the Philippine market. What can be an equally effective medicinal alternative, especially in far-flung communities and provinces, to relieve muscles and joint pains and prove to be non-costly?

Correct answer: D

Rationale: Yerba Buena is a suitable alternative for muscle and joint pain relief, particularly in remote areas due to its cost-effectiveness and proven efficacy. Sambong is more commonly used for urinary tract problems, Lagundi is known for respiratory conditions, and Akapulko is primarily used for skin diseases, making them less effective alternatives for muscle and joint pain relief.

3. The nurse is planning care for a client with pneumococcal pneumonia. Which of the following would be most effective in removing respiratory secretions?

Correct answer: B

Rationale: Increasing oral fluid intake to 3000 cc per day is the most effective in removing respiratory secretions in a client with pneumococcal pneumonia. Adequate hydration helps thin secretions, making them easier to expectorate. Administration of cough suppressants (Choice A) may hinder the removal of secretions by suppressing the cough reflex. Maintaining bed rest with bathroom privileges (Choice C) is important but does not directly address the removal of respiratory secretions. Performing chest physiotherapy (Choice D) is beneficial for mobilizing secretions but may not be as effective as increasing fluid intake in thinning and facilitating the removal of secretions.

4. The nurse is preparing to discharge an elderly, recently widowed female client following a mild stroke. At this time she is able to walk with the aid of a walker. As part of the discharge planning, what referral is most important for the nurse to make?

Correct answer: B

Rationale: The most important referral for the nurse to make for the elderly, recently widowed female client who had a mild stroke and limited mobility is Meals-on-Wheels. This service will ensure she receives proper nutrition and support given her circumstances. Pastoral care may provide emotional and spiritual support but is not as essential in this scenario. Grief support group could be beneficial but addressing her nutritional needs takes precedence. Physical therapy may be important for rehabilitation but ensuring proper nutrition is more critical at this time.

5. What is the process of enabling people to increase control over and improve their health known as?

Correct answer: A

Rationale: The correct answer is A: Health promotion. Health promotion focuses on empowering individuals to take control of their health by promoting healthy behaviors, lifestyles, and environments. It aims to prevent illnesses and enhance overall well-being. Choices B, C, and D are incorrect because they do not fully encompass the concept of empowering individuals to improve their health. Disease prevention specifically targets avoiding specific illnesses, rehabilitation focuses on restoring health after an illness or injury, and health education primarily involves imparting knowledge about health-related topics.

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