Nursing Process 1 Test Questions

Nursing Process 1 Test Questions Related

Review Nursing Process 1 Test Questions related questions and content

A client is being treated for acute pyelonephritis and will undergo laboratory tests. These tests are expected to help determine the clients BUN, creatinine, and serum electrolyte levels. Why should the nurse evaluate these test results?

  • A. To determine the severity of the disorder
  • B. To identify signs of fluid retention
  • C. To determine the location of discomfort
  • D. To determine clients response to therapy
Correct Answer: D

Rationale: The correct answer is D: To determine clients response to therapy. Evaluating BUN, creatinine, and serum electrolyte levels in a client being treated for acute pyelonephritis helps the nurse assess the effectiveness of the therapy. Changes in these levels indicate how well the kidneys are functioning and how the client is responding to treatment. Monitoring these parameters allows for adjustments in therapy if needed.

Incorrect choices:
A: To determine the severity of the disorder - While these tests can provide information about the severity of kidney dysfunction, the primary focus is on monitoring the response to therapy.
B: To identify signs of fluid retention - While BUN and creatinine levels can indirectly indicate fluid status, the main purpose of evaluating these tests is to assess therapy response.
C: To determine the location of discomfort - These tests do not provide information about the location of discomfort but rather focus on kidney function and response to treatment.

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A patient understands the common causes of urinary tract infection if he or she states the following, EXCEPT:

  • A. “UTI can be caused by holding the urge to urinate.”
  • B. “Insertion of instruments and catheter to the urinary tract can introduce bacteria that can cause infection.”
  • C. “I usually drink lots of water at night and it might have caused my UTI.”
  • D. “UTI can be caused by unhygienic cleaning after defecation.”
Correct Answer: C

Rationale: Rationale: Choice C is the correct answer because drinking lots of water at night actually helps prevent UTIs by flushing out bacteria from the urinary tract. Holding the urge to urinate (Choice A) can increase the risk of UTIs as bacteria can multiply in stagnant urine. Insertion of instruments and catheters (Choice B) can introduce bacteria, leading to infection. Unhygienic cleaning after defecation (Choice D) can also introduce bacteria to the urinary tract, causing UTIs. Therefore, Choice C is the exception as it does not contribute to the common causes of UTIs.

Blood cells are formed in the:

  • A. Arterioles
  • B. Lymphoid tissue
  • C. Bone marrow
  • D. Muscle tissue
Correct Answer: C

Rationale: The correct answer is C: Bone marrow. Blood cells are primarily formed in the bone marrow through a process called hematopoiesis. The bone marrow contains stem cells that differentiate into various types of blood cells, including red blood cells, white blood cells, and platelets. Arterioles are small blood vessels that carry blood away from the heart, not involved in blood cell formation. Lymphoid tissue plays a role in immune function but not in blood cell production. Muscle tissue is primarily responsible for movement and does not have a role in blood cell formation. Therefore, the bone marrow is the correct answer as it is the main site of blood cell production in the body.

A Jewish client has been diagnosed with ulcerative colitis. A nursing diagnosis appropriate for a client who has ulcerative colitis is:

  • A. abdominal pain related to decreased peristalsis
  • B. diarrhea related to hyperosmolar intestinal contents
  • C. fluid volume excess related to increase water absorption by intestinal mucosa
  • D. activity intolerance related to fatigue
Correct Answer: A

Rationale: The correct answer is A: abdominal pain related to decreased peristalsis. Ulcerative colitis causes inflammation and ulcers in the colon, leading to abdominal pain due to decreased peristalsis. This impairs the movement of stool through the colon, resulting in pain.

Choice B is incorrect as diarrhea is a common symptom of ulcerative colitis, not hyperosmolar intestinal contents. Choice C is incorrect as ulcerative colitis often leads to diarrhea and not fluid volume excess. Choice D is incorrect as activity intolerance is not directly related to ulcerative colitis, whereas abdominal pain is a common symptom associated with the condition.

Which of the ff is the best dietary advice to maximize the immune function in healthy people?

  • A. Include immune enhancing formulas
  • B. Avoid polyunsaturated fatty acids
  • C. Increase intake of essential fatty acids and omega 3 fatty acids
  • D. Follow a balanced and varied diet CARING FOR CLIENT WITH IMMUNE MEDIATED DISORDERS
Correct Answer: D

Rationale: Step-by-step rationale:
1. A balanced and varied diet provides essential nutrients for immune function.
2. Including a wide range of foods ensures intake of vitamins, minerals, and antioxidants crucial for immune health.
3. Avoiding extremes like excessive immune-enhancing formulas or eliminating polyunsaturated fatty acids maintains balance.
4. Essential fatty acids and omega-3 fatty acids are beneficial but should be part of a well-rounded diet.
5. For clients with immune-mediated disorders, individualized dietary advice may be necessary.

Summary:
- A: Immune-enhancing formulas may not be necessary and could disrupt balance.
- B: Avoiding all polyunsaturated fatty acids is not advisable as some are essential for health.
- C: Increasing essential fatty acids is beneficial but should be part of a balanced diet.

A client, age 42, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?

  • A. Onset of sporadic sexual activity at age 17
  • B. Pregnancy complicated with eclampsia at
  • C. Spontaneous abortion at age 19 age 27
  • D. Human papilloma virus infection at age 32
Correct Answer: D

Rationale: The correct answer is D: Human papilloma virus (HPV) infection at age 32. HPV is a known risk factor for cervical cancer as it can lead to cellular changes in the cervix. Here's the rationale:
1. HPV is a sexually transmitted infection that can cause abnormal cell growth in the cervix.
2. Persistent HPV infection is a major risk factor for developing cervical cancer.
3. Age 32 is within the typical age range for HPV infection and the development of cervical cancer.
4. Choices A, B, and C are unrelated to the primary risk factor for cervical cancer, which is HPV infection.

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