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Whoch of the ff. is a desired outcome for the nursing diagnosis of acute pain for a patient with acute thrombophlebitis?
- A. States anxiety is decreased
- B. States pain is satisfactorily relieved c.Is able to participate in desired activities
- C. Reports ability to ambulate without pain
Correct Answer: C
Rationale: A desired outcome for the nursing diagnosis of acute pain related to acute thrombophlebitis would be for the patient to be able to participate in desired activities. By achieving pain relief and being able to engage in activities they enjoy or find important, the patient's overall quality of life can be improved. This outcome focuses on enhancing the patient's ability to function and maintain independence despite the pain associated with the thrombophlebitis. It reflects a holistic approach to care that considers the patient's physical, emotional, and social well-being. Ultimately, the goal is to help the patient achieve a level of comfort and mobility that allows them to resume their desired activities.
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Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight?
- A. Postterm
- B. Preterm
- C. Low birth weight
- D. Small for gestational age
Correct Answer: B
Rationale: The term "preterm" refers to a newborn born before completion of week 37 of gestation, regardless of birth weight. Preterm birth can lead to various health issues for the newborn, as they may not have fully developed before being born. It is important for healthcare providers to closely monitor preterm infants to ensure they receive the proper care and support for their development.
The parent of a child with glomerulonephritis asks how they will know the child is improving. Which is the best response?
- A. Your child's urine output will increase and the urine will become less tea-colored.
- B. Your child will rest more comfortably as lab values normalize.
- C. Your child's appetite will decrease.
- D. Your child's lab values will become more normal.
Correct Answer: A
Rationale: An increase in urine output and a return to normal urine color are clear, observable signs of improvement in glomerulonephritis.
A client is undergoing peritoneal dialysis. Which of the ff is a major complication of the procedure that the nurse should monitor for?
- A. Internal hemorrhage
- B. Hydronephrosis
- C. Ecchymosis
- D. Peritonitis
Correct Answer: D
Rationale: Peritonitis is a major complication of peritoneal dialysis that the nurse should monitor for. Peritonitis is an infection of the peritoneum, the membrane that lines the abdominal cavity and covers the abdominal organs. It can occur when bacteria from the dialysis solution enter the peritoneal cavity. Symptoms of peritonitis may include abdominal pain, cloudy dialysis effluent, fever, and general signs of infection. Prompt recognition and treatment of peritonitis are crucial to prevent complications such as sepsis and peritoneal membrane damage. Regular monitoring and strict aseptic technique during peritoneal dialysis can help reduce the risk of peritonitis.
A client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
- A. Hair loss.
- B. Fatigue.
- C. Stomatitis.
- D. Vomiting.
Correct Answer: A
Rationale: Radiation therapy works by targeting rapidly dividing cells in the body, which includes not only cancer cells but also healthy cells. Hair loss, also known as alopecia, is a common side effect of radiation therapy because the hair follicles are fast-growing cells that can be affected by the radiation. The extent of hair loss can vary depending on the dose and area of the body being treated. It is essential for nurses to prepare clients for the possibility of hair loss during radiation therapy and provide support and information on managing this side effect.
Which of the following statements is true regarding Joel's disorder? a.Hemophilia is an autosomal dominant disorder in which the woman carries the trait
- A. Hemophilia follows regular laws of Mendelian inherited disorders such as sickle ceil anemia
- B. This disorder can be carried by either male or female but occurs in the sex opposite that of the carrier
- C. Hemophilia is an X-linked disorder in which the mother is usually the carrier of the illness but is not affected by it
Correct Answer: C
Rationale: Hemophilia is an X-linked disorder, meaning the gene responsible for hemophilia is carried on the X chromosome. Typically, hemophilia is passed down from a carrier mother to her male offspring who then express the disorder. This is because males have only one X chromosome (inherited from their mother), making them more vulnerable to X-linked disorders. Females have two X chromosomes, which means that even if one carries the hemophilia gene, the other X chromosome may carry a normal gene that can compensate, making females less likely to exhibit symptoms of hemophilia. In this case, Joel's disorder aligns with the typical pattern of inheritance for hemophilia as described in statement C.