The nurse rates a patient's biceps muscle strength at 3. Another nurse reading this rating would expect the patient's best movement of the muscle to be at which functional level?
1. Passive ROM
2. Active ROM with gravity and moderate weakness
3. Complete active ROM with minimal weakness
4. Complete ROM with no weakness
2
Rationale 1: A muscle that moves only during passive ROM by the examiner is documented as grade 2.
Rationale 2: If the patient has active ROM with gravity but the muscle is moderately weak, it is documented as grade 3.
Rationale 3: Complete active ROM in a muscle with only minimal weakness is documented as grade 4.
Rationale 4: If the patient has complete ROM against gravity and resistance, the muscle strength is normal and is documented as grade 5.
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After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize?
1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a three-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than six months
After teaching a class on preventing pelvic inflammatory disease, the instructor determines that the teaching was successful when the class identifies which of the following as an effective method?
A) HIV B) HSV C) HPV D) HAV E) HBV
The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement?
1. "I can still have my after-dinner drink." 2. "I need to increase fluids while taking this medication." 3. "This medication is safe because it is sold over-the-counter (OTC)." 4. "This medication could make me very sleepy."
Which of the following questions in the assessment of a client with anxiety is most clinically appropriate?
A) "What can I give you to make you feel less anxious right now?" B) "Does your anxiety make you feel less valuable and competent as a person?" C) "Do you think that you're justified in feeling anxious right now?" D) "How do you feel about everything that is happening in your life right now?"