foundation of nursing questions and answers

foundation of nursing questions and answers Related

Review foundation of nursing questions and answers related questions and content

A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient?

  • A. Position the patient in the high Fowlers position whenever possible.
  • B. Temporarily eliminate animal protein from the patients diet.
  • C. Make sure the patient eats at least two servings of raw fruit each day.
  • D. Obtain a stool culture to identify possible pathogens.
Correct Answer: D

Rationale: The correct answer is D: Obtain a stool culture to identify possible pathogens. This is the most appropriate nursing intervention because chronic diarrhea in a patient with AIDS can be caused by various pathogens such as parasites, bacteria, or viruses. By obtaining a stool culture, the healthcare team can identify the specific pathogen responsible for the diarrhea and initiate targeted treatment.

A: Positioning the patient in the high Fowler's position is not directly related to addressing the underlying cause of chronic diarrhea in this patient.

B: Temporarily eliminating animal protein from the patient's diet may not be necessary or effective in treating chronic diarrhea without knowing the specific cause identified through stool culture.

C: Making sure the patient eats raw fruit is not recommended as raw fruits can sometimes worsen diarrhea due to their high fiber content and potential for carrying pathogens.

In summary, obtaining a stool culture is the most appropriate intervention as it helps identify the specific pathogen causing the diarrhea, while the other options do not directly address the underlying cause.

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A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis?

  • A. The patient is not a surgical candidate.
  • B. The patients breast cancer is considered highly treatable.
  • C. There is a 10% chance that the patients cancer will self-resolve.
  • D. The patient has a 15% chance of 5-year survival.
Correct Answer: A

Rationale: Rationale for Correct Answer A: Stage IV breast cancer indicates distant metastasis, making the patient ineligible for curative surgery. Treatment for stage IV focuses on palliative care to manage symptoms and improve quality of life.

Summary of Other Choices:
B: Stage IV breast cancer is not considered highly treatable as it has spread beyond the breast and nearby lymph nodes, making it more challenging to cure.
C: There is no evidence to suggest that stage IV breast cancer will self-resolve. The prognosis for metastatic breast cancer is typically poor.
D: The 5-year survival rate for stage IV breast cancer is generally lower than 15%, making this choice incorrect.

A patient diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the patients care, the nurse should be aware that the effects of the tumor will primarily depend on what variable?

  • A. Whether the tumor utilizes aerobic or anaerobic respiration
  • B. The specific hormones secreted by the tumor
  • C. The patients pre-existing health status
  • D. Whether the tumor is primary or the result of metastasis
Correct Answer: B

Rationale: The correct answer is B: The specific hormones secreted by the tumor. Pituitary adenomas are known to secrete hormones that can lead to various endocrine disorders. Understanding the specific hormones secreted by the tumor is crucial in determining the clinical manifestations and planning appropriate treatment. Choices A, C, and D are incorrect because the primary determinant of the effects of the tumor in this case is the hormonal activity rather than whether the tumor uses aerobic or anaerobic respiration, the patient's pre-existing health status, or whether the tumor is primary or metastatic.

Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome?

  • A. Abdominal palpation
  • B. Venous sample of blood
  • C. Checking deep tendon reflexes
  • D. Auscultation of the heart and lungs
Correct Answer: A

Rationale: The correct answer is A: Abdominal palpation. Palpating the abdomen can potentially cause rupture of the liver in patients with HELLP syndrome due to increased risk of liver hematoma. This can lead to severe bleeding and compromise the patient's condition. Checking deep tendon reflexes (C), auscultation of the heart and lungs (D), and venous sample of blood (B) are safe assessments that do not pose a risk of exacerbating the patient's condition. It is crucial to prioritize patient safety and avoid interventions that can harm the patient, making avoiding abdominal palpation the correct choice in caring for a patient with HELLP syndrome.

In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?

  • A. Supplement breast milk with corn syrup.
  • B. Give cow’s milk during the first year of life.
  • C. Add honey to infant formulas for increased energy.
  • D. Provide breast milk or formula for the first 4 to 6 months.
Correct Answer: D

Rationale: The correct answer is D because breast milk or formula is recommended for the first 4 to 6 months as it provides essential nutrients for infant growth and development. Choosing A, B, or C is incorrect as they pose health risks to infants - corn syrup is not necessary, cow's milk is not suitable for infants, and honey can cause botulism in infants under 1 year old. Breast milk or formula is the safest and most nutritionally balanced option for infants in the first few months of life.

A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family?

  • A. The patient should not be in contact with the baby after delivery.
  • B. The patients treatment poses no risk to his daughter or her infant.
  • C. The patients brachytherapy may be contraindicated for safety reasons.
  • D. The patient should avoid close contact with his daughter for 2 months.
Correct Answer: B

Rationale: The correct answer is B because brachytherapy does not pose a risk to the patient's daughter or her unborn child. Brachytherapy involves placing radioactive sources inside or near the tumor, which does not make the patient radioactive. The radiation does not travel far and does not pose a risk to others. Therefore, the daughter and her infant are safe from any radiation exposure. Choices A, C, and D are incorrect because there is no need for the patient to avoid contact with the baby after delivery, the brachytherapy is not contraindicated for safety reasons, and there is no requirement for the patient to avoid close contact with his daughter for 2 months.

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