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A nurse is teaching a patient with osteoarthritis about managing their condition. Which of the following statements by the patient indicates the need for further education?
- A. I will use heat or cold therapy to relieve joint pain.
- B. I will take my pain medication regularly.
- C. I will exercise regularly to strengthen my joints.
- D. I will avoid physical activity to prevent joint strain.
Correct Answer: D
Rationale: The correct answer is D because avoiding physical activity to prevent joint strain is not recommended for managing osteoarthritis. Exercise is crucial for strengthening joints and improving flexibility. Choice A is correct as heat or cold therapy can help relieve joint pain. Choice B is correct as taking pain medication regularly can help manage symptoms. Choice C is correct as regular exercise is important for maintaining joint health. In summary, avoiding physical activity is not a recommended approach for managing osteoarthritis, unlike the other choices which are beneficial for the condition.
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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 caring for a patient with a history of chronic liver disease. The nurse should monitor for which of the following complications?
- A. Anemia.
- B. Jaundice.
- C. Hypertension.
- D. Hypoglycemia.
Correct Answer: B
Rationale: The correct answer is B: Jaundice. In chronic liver disease, impaired liver function leads to the accumulation of bilirubin in the blood, causing jaundice. Jaundice is a common complication seen in patients with liver disease. Anemia (choice A) may occur in liver disease but is not as specific as jaundice. Hypertension (choice C) is not a direct complication of liver disease. Hypoglycemia (choice D) is more commonly associated with pancreatic disorders, not liver disease. Therefore, monitoring for jaundice is crucial in patients with chronic liver disease.
The nurse has implemented several planned interventions to address the nursing diagnosis of acute pain. Which of the following would be the next appropriate action?
- A. Establishing priorities
- B. Identifying expected outcomes
- C. Evaluating the individual's condition and comparing actual outcomes with expected outcomes
- D. Interpreting data, identifying clusters of cues, and making inferences
Correct Answer: C
Rationale: The next appropriate action is to evaluate the individual's condition and compare actual outcomes with expected outcomes (Choice C). This step is crucial in determining the effectiveness of the implemented interventions in addressing the nursing diagnosis of acute pain. By evaluating the individual's condition, the nurse can assess whether the interventions have been successful in alleviating the pain. Comparing actual outcomes with expected outcomes helps in identifying any discrepancies and adjusting the plan of care accordingly to ensure optimal patient outcomes.
Establishing priorities (Choice A) is important but would come before implementing interventions. Identifying expected outcomes (Choice B) is necessary before implementing interventions but does not directly address the need for evaluation. Interpreting data and making inferences (Choice D) is part of the assessment phase and not the next appropriate action after implementing interventions.
The nurse is preparing to assess a hospitalized patient who is experiencing significant shortness of breath. How should the nurse proceed with the assessment?
- A. Examine only the body areas related to the problem for which the patient is hospitalized, and then do a complete assessment after the problem has been resolved.
- B. Perform a mini-database by examining the body areas directly related to the problem for which the patient is hospitalized.
- C. Consider this a normal finding, and proceed with the abdominal assessment.
- D. Examine the entire body to determine if the problem is linked to something else.
Correct Answer: A
Rationale: The correct answer is A because when a patient is experiencing significant shortness of breath, the nurse should initially focus on assessing the areas directly related to the presenting problem to address the immediate issue. This approach allows for prompt intervention and treatment of the patient's acute condition. Once the patient's respiratory distress is managed, the nurse can then proceed with a complete assessment to identify any underlying or additional health issues. This stepwise approach ensures that the patient's urgent needs are met first before conducting a comprehensive assessment.
Choices B, C, and D are incorrect because:
B: Performing a mini-database by only examining body areas directly related to the problem may not provide a comprehensive understanding of the patient's condition and could overlook other potential health issues.
C: Dismissing significant shortness of breath as a normal finding and proceeding with an abdominal assessment is inappropriate and could delay necessary interventions for the respiratory distress.
D: Examining the entire body to determine if the problem is linked to something else is inefficient and
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.