The nurse is collecting data to determine the client’s risk factors related to cervical cancer. The nurse determines which information to be significant?
Multiple sexual partners.
Multiple pregnancies.
Late onset of menarche.
Use of a diaphragm.
The Correct Answer is A
Choice A rationale
Multiple sexual partners increase the risk of human papillomavirus (HPV) infection, which is a significant risk factor for cervical cancer.
Choice B rationale
Multiple pregnancies are not a significant risk factor for cervical cancer.
Choice C rationale
Late onset of menarche is not a significant risk factor for cervical cancer.
Choice D rationale
Use of a diaphragm is not a significant risk factor for cervical cancer.
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Correct Answer is D
Explanation
Choice A rationale
Stating that the client had an allergic reaction to the ordered meperidine is not objective and does not provide specific details about the client’s condition.
Choice B rationale
Notifying the primary health care provider because the client developed a rash after receiving an opioid analgesic is important, but it does not include all the necessary details about the client’s condition.
Choice C rationale
Documenting that the client’s skin was warm and flushed, and a rash was noted on the chest and back is important, but it does not include the timing of the reaction or the client’s temperature.
Choice D rationale
Documenting that thirty minutes after receiving meperidine, the temperature was 101°F (38.3°C), the client’s skin was warm and flushed, and a rash was noted on the chest and back provides a complete and objective account of the client’s condition and the timing of the reaction.
Correct Answer is B
Explanation
Choice A rationale
The Visual Analog Scale is used for older children and adults who can understand and communicate their pain level.
Choice B rationale
The FLACC scale (Face, Legs, Activity, Cry, Consolability) is specifically designed for assessing pain in infants and young children who are unable to communicate their pain verbally.
Choice C rationale
The Oucher scale is used for children aged 3 to 12 years and involves matching facial expressions to a pain level.
Choice D rationale
The Faces scale is used for children aged 3 years and older who can point to a face that best represents their pain level.