A nurse is performing passive range of motion (ROM) and splinting on an at-risk patient. The absence of which finding will indicate goal achievement for the nurse's action?
Atelectasis
Joint contractures
Pressure ulcers
Renal calculi
The Correct Answer is B
A. Atelectasis is prevented primarily through deep breathing exercises and respiratory interventions, not passive ROM.
B. Passive ROM and splinting help prevent joint contractures by maintaining joint mobility and alignment, so the absence of contractures indicates successful prevention.
C. Pressure ulcers are avoided through regular repositioning and skin care rather than passive ROM alone.
D. Renal calculi are primarily prevented through hydration and diet, not passive ROM or splinting.
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Correct Answer is B
Explanation
A. The definition of spirituality does not typically include concepts of fire or giving life; this option does not accurately capture the essence of spirituality.
B. Awareness of one's inner self encompasses the essence of spirituality, focusing on personal beliefs, values, and the search for meaning, which is widely recognized in health care.
C. Spirituality is often considered equally essential to physical needs, especially in holistic approaches to health and well-being, making this statement misleading.
D. Spirituality can have a significant impact on health, influencing coping mechanisms and overall well-being; therefore, labeling it as having a minor effect is not accurate.
Correct Answer is A
Explanation
A. After a nurse is exposed to blood from a cut by a used scalpel, it is crucial to test the patient for bloodborne pathogens (e.g., HIV, hepatitis B, hepatitis C) and to offer post-exposure prophylaxis or treatment to the nurse if indicated.
B. While removing gloves and disposing of them properly is part of standard infection control practices, it is not the primary process required after an exposure incident.
C. Although the nurse should report the incident, providing a medical evaluation should follow the protocols established by the facility, not just the manager's assessment.
D. Properly disposing of the scalpel in a sharps container is necessary for safety but does not directly address the required process for managing exposure to blood.