this sign reflex is used to diagnose meningitis this sign reflex is used to diagnose meningitis
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Nursing Elites

ATI RN

ATI Community Health Nursing Ch 7

1. Which sign or reflex is used to diagnose meningitis?

Correct answer: Brudzinski

Rationale: Brudzinski sign is a physical exam finding used to diagnose meningitis. It is elicited by flexing the patient's neck, resulting in involuntary flexion of the hips and knees. This maneuver indicates meningeal irritation, a common feature in meningitis. Homan’s sign is used to assess for deep vein thrombosis, Startle is a reflex response to sudden stimuli, and the Anterior drawer test is used to diagnose ligamentous instability in the knee.

2. For patients with anemia, which vitamin is crucial for the absorption of iron?

Correct answer: B

Rationale: The correct answer is Vitamin C. Vitamin C enhances the absorption of non-heme iron, which is crucial for patients with anemia. Vitamin A (Choice A) is not directly involved in iron absorption. Vitamin D (Choice C) helps with calcium absorption, not iron. Vitamin E (Choice D) does not have a significant role in iron absorption.

3. A nurse is providing teaching to a group of older adults about sources of complete and incomplete protein. Which of the following foods should the nurse include as a complete protein?

Correct answer: A: Yogurt

Rationale: Yogurt is the correct answer as it is a complete protein source, containing all nine essential amino acids. Fresh vegetables, nuts, and dried beans are incomplete protein sources as they lack one or more essential amino acids required by the body.

4. The nurse is caring for an infant whose parent reports the infant takes a bottle to go to sleep. What should the nurse instruct to prevent baby bottle tooth decay?

Correct answer: A

Rationale: The correct answer is A, Water. Water is recommended to prevent baby bottle tooth decay caused by sugary substances present in milk, formula, or fruit juice. Water does not contain sugars that can contribute to tooth decay, unlike the other options. Milk, formula, and unsweetened fruit juice can all lead to tooth decay if the baby falls asleep with them in their mouth, as the sugars can linger on the teeth and cause decay over time. Iron-fortified formula, although beneficial for the infant's nutrition, still contains sugars that can be harmful to the teeth.

5. The client with peripheral vascular disease is being taught by the nurse. Which interventions should the nurse discuss with the client?

Correct answer: D

Rationale: The correct interventions for a client with peripheral vascular disease include keeping the area between the toes dry and wearing comfortable, well-fitting shoes. Choice A is correct as moisture between the toes can lead to skin breakdown and infection. Choice B is also correct as proper footwear helps prevent injury and promotes circulation. Choice C, cutting toenails straight across, is incorrect for peripheral vascular disease clients as cutting them in an arch can reduce the risk of ingrown toenails, which is important for clients with diabetes to prevent complications. Therefore, choices A and B are the most appropriate interventions for the client with peripheral vascular disease.

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