Nursing Process Practice Questions

Nursing Process Practice Questions Related

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.A client complains of urinary discomfort and a burning sensation while urinating. A urethral smear shows evidence of urethritis, and the client is prescribed antibiotics and instructed to drink 2-3 L of water daily. For which of the ff reasons is the client advised to drink the specified amount of water?

  • A. It will help him overcome urinary incontinence
  • B. It will promote renal blood flow and flush bacteria from the urinary tract
  • C. It will help him eliminate urinary odors
  • D. It will provide relief from pain and discomfort as a result of urinary tract infection DISTURBANCES IN FLUIDS AND ELECTROLYTES
Correct Answer: B

Rationale: Step 1: Antibiotics are prescribed to treat urethritis, indicating a bacterial infection in the urinary tract.
Step 2: Increasing water intake (2-3 L daily) promotes renal blood flow, dilutes urine, and helps flush out bacteria from the urinary tract, aiding in the elimination of infection.
Step 3: Adequate hydration helps prevent the formation of concentrated urine, reducing the risk of recurrent urinary tract infections.
Step 4: Therefore, choice B is correct as it directly addresses the underlying cause of the client's symptoms.
Summary: Choices A, C, and D are incorrect as they do not directly target the bacterial infection causing the urinary discomfort. Drinking water will not specifically help with incontinence, eliminate odors, or provide pain relief.

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Which of the following statements would be most appropriate when assisting a patient who has the nursing diagnosis ofAltered Thought Process with Persona! Hygiene Needs?

  • A. "What would you like to do first, brush your teeth?"
  • B. "Where is y our toothbrush?"
  • C. "When would you like to have your bath?"
  • D. "Would you like to brush your teeth, or do you want me to do it for you? it's good to do things for yourself."
Correct Answer: D

Rationale: Rationale:
- Choice D is correct as it offers the patient autonomy and promotes self-care, which is important for maintaining independence and dignity.
- By giving the patient a choice between brushing their own teeth or having assistance, it empowers them to make decisions.
- Choices A, B, and C are not as appropriate because they do not address the patient's autonomy and may come across as directive or intrusive, which can further exacerbate the altered thought process.

The nurse is caring for a client in the emergency room diagnosed with Bell’s palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. The nurse anticipates that the antidote to be prescribed is:

  • A. Pentostatin (Nipent)
  • B. Fludarabine (Fludara)
  • C. Auranofin (Ridaura)
  • D. Acetylcysteine Mucomyst)
Correct Answer: D

Rationale: Rationale: Acetylcysteine (Mucomyst) is the antidote for acetaminophen overdose. It works by replenishing glutathione, which helps neutralize the toxic metabolite of acetaminophen. Pentostatin, Fludarabine, and Auranofin are not antidotes for acetaminophen overdose and are used for different conditions. Acetylcysteine is the correct choice as it directly counteracts the toxic effects of acetaminophen.

The nurse knows which of the following is true about immunity?

  • A. Antibody-mediated defense occurs through the T-cell system
  • B. Cellular immunity is mediated by antibodies produced by the B-cells
  • C. Antibodies are produced by the B-cells
  • D. Lymphocytes increase with an allergic response
Correct Answer: C

Rationale: Rationale:
Choice C is correct because antibodies are indeed produced by B-cells as part of the adaptive immune response. B-cells differentiate into plasma cells that produce antibodies to target specific antigens. This process is essential for generating immunity against pathogens.

Incorrect Choices:
A: Antibody-mediated defense occurs through the B-cell system, not the T-cell system. T-cells are involved in cell-mediated immunity.
B: Cellular immunity is mediated by T-cells, not antibodies produced by B-cells. T-cells directly attack infected cells.
D: Lymphocytes can increase during an allergic response, but this does not specifically relate to immunity through antibody production by B-cells.

During a breast examination, which finding most strongly suggests that the client has breast cancer?

  • A. Slight asymmetry of the breasts
  • B. A fixed nodular mass with dimpling of the overlying skin
  • C. Bloody discharge from the nipple
  • D. Multiple firm, round, freely movable masses that change with the menstrual cycle
Correct Answer: B

Rationale: The correct answer is B because a fixed nodular mass with dimpling of the overlying skin is highly indicative of breast cancer. This finding suggests an invasive tumor pulling on the skin, causing dimpling. Other choices are incorrect because slight breast asymmetry (A) is common, bloody nipple discharge (C) can be benign or due to other conditions, and multiple freely movable masses (D) are more indicative of benign breast conditions like fibrocystic changes.

The thymus gland role with the immune system is which of the following?

  • A. Maturates B cells
  • B. Maturates platelets
  • C. Maturates red blood cells
  • D. Maturates T cells
Correct Answer: D

Rationale: The correct answer is D: Maturates T cells. The thymus gland is crucial for the maturation of T cells, a type of white blood cell that plays a central role in the adaptive immune response. T cells mature in the thymus through a process of selection and education, where they learn to distinguish self from non-self antigens. This process is essential for the development of a functional immune system. Choices A, B, and C are incorrect because the thymus gland does not play a role in the maturation of B cells, platelets, or red blood cells, respectively.

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