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A nurse is caring for a patient with acute pancreatitis. The nurse should monitor for which of the following signs of complications?
- A. Decreased urine output and increased thirst.
- B. Increased blood pressure and heart rate.
- C. Hypotension and tachycardia.
- D. Tachypnea and cyanosis.
Correct Answer: C
Rationale: The correct answer is C: Hypotension and tachycardia. In acute pancreatitis, complications like hypovolemic shock can lead to hypotension and tachycardia due to fluid shifts and inflammation. Decreased urine output and increased thirst (A) may indicate dehydration but are not specific to pancreatitis. Increased blood pressure and heart rate (B) are not typical signs of complications in pancreatitis. Tachypnea and cyanosis (D) suggest respiratory distress, which is not a common complication of pancreatitis.
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A nurse is teaching a patient with diabetes about insulin administration. Which of the following statements by the patient indicates proper understanding?
- A. I will inject insulin into my arm to ensure faster absorption.
- B. I will rotate injection sites to avoid tissue damage.
- C. I should inject insulin only when my blood glucose is elevated.
- D. I should inject insulin into the same spot every time to ensure consistency.
Correct Answer: B
Rationale: The correct answer is B: I will rotate injection sites to avoid tissue damage. This statement indicates proper understanding because rotating injection sites helps prevent tissue damage and ensures consistent absorption. Injecting into the same spot every time can lead to lipohypertrophy. Injecting insulin only when blood glucose is elevated is incorrect as insulin is needed regularly. Injecting into the arm for faster absorption is also incorrect, as it can lead to unpredictable absorption rates. Rotation of sites is crucial for optimal insulin absorption and to prevent complications.
A nurse is caring for a patient with a history of alcohol abuse. The nurse should be aware that this patient is at increased risk for which of the following complications?
- A. Chronic liver disease.
- B. Chronic kidney disease.
- C. Pulmonary embolism.
- D. Stroke.
Correct Answer: A
Rationale: The correct answer is A: Chronic liver disease. Patients with a history of alcohol abuse are at increased risk for chronic liver disease due to the toxic effects of alcohol on the liver. Alcohol can lead to fatty liver, alcoholic hepatitis, cirrhosis, and liver cancer. The liver plays a crucial role in metabolizing alcohol, and excessive alcohol consumption can overwhelm the liver's ability to detoxify the body. Chronic kidney disease (B), pulmonary embolism (C), and stroke (D) are not directly associated with alcohol abuse. Kidney disease is more commonly linked to conditions like diabetes and hypertension, pulmonary embolism is often related to blood clotting disorders, and stroke can be caused by factors such as hypertension and atherosclerosis.
A nurse is teaching a patient with diabetes about foot care. Which of the following statements by the patient indicates proper understanding?
- A. I will inspect my feet daily for cuts or blisters.
- B. I will wear tight shoes to avoid blisters.
- C. I will avoid trimming my toenails to prevent injury.
- D. I will not worry about foot care unless I experience pain.
Correct Answer: A
Rationale: The correct answer is A because daily inspection helps identify issues early, preventing complications. B is incorrect as tight shoes can cause blisters. C is wrong as proper toenail trimming is essential. D is incorrect because prevention is key in diabetic foot care.
The nurse is conducting an interview with a woman who has recently learned that she is pregnant and has come to the clinic to begin prenatal care. The woman states that she and her husband are excited about the pregnancy but have a few questions. She looks nervously at her hands during the interview and sighs audibly. Which of the following statements does the nurse know is most accurate, considering the concept of communication?
Correct Answer: B
Rationale: The correct answer is B because the woman's nonverbal cues (looking nervously at her hands, sighing audibly) indicate potential anxiety or stress. The nurse should acknowledge these cues and explore her feelings further to provide appropriate support. Option A is incorrect as it does not address the woman's nonverbal cues. Option C is incorrect as it assumes the woman is not genuinely excited about the pregnancy. Option D is incorrect as it overlooks the woman's nonverbal cues and does not address her potential emotional needs.
A patient with heart failure is experiencing shortness of breath, fatigue, and swelling in the legs. The nurse should monitor for signs of which of the following complications?
- A. Pulmonary embolism.
- B. Renal failure.
- C. Liver failure.
- D. Worsening heart failure.
Correct Answer: D
Rationale: The correct answer is D: Worsening heart failure. Shortness of breath, fatigue, and leg swelling are common symptoms of heart failure. Monitoring for signs of worsening heart failure, such as increased dyspnea, weight gain, and decreased exercise tolerance, is crucial. Pulmonary embolism (A) presents with sudden chest pain and shortness of breath, not typically associated with chronic heart failure. Renal failure (B) may present with decreased urine output and electrolyte imbalances. Liver failure (C) may present with jaundice and changes in mental status. However, given the symptoms presented by the patient, monitoring for worsening heart failure is the most appropriate choice.