Pharmacology and the Nursing Process 10th Edition Test Bank Quizlet

Pharmacology and the Nursing Process 10th Edition Test Bank Quizlet Related

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A patient has reduced muscle strength following a left-sided stroke and is at risk for falling. Which intervention is most appropriate for the nursing diagnostic statement Risk for falls?

  • A. Keep all side rails down at all times.
  • B. Encourage patient to remain in bed most of the shift.
  • C. Place patient in room away from the nurses’ station if possible.
  • D. Assist patient into and out of bed every 4 hours or as tolerated.
Correct Answer: D

Rationale: The correct answer is D. This intervention is appropriate because it addresses the patient's reduced muscle strength following a left-sided stroke and the risk for falling. Assisting the patient into and out of bed regularly helps prevent falls by ensuring safe mobility and reducing the likelihood of accidents. It promotes independence while also providing necessary support.

A: Keeping all side rails down at all times may increase the risk of falls as it removes a safety measure that can help prevent falls.
B: Encouraging the patient to remain in bed most of the shift can lead to deconditioning and muscle weakness, increasing the risk of falls.
C: Placing the patient in a room away from the nurses' station does not directly address the risk for falls and may hinder timely assistance in case of emergencies.

In summary, option D is the most appropriate intervention as it addresses the patient's needs, promotes safety, and supports mobility to prevent falls effectively.

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A classic full blown AIDS case is identified by clinical manifestations such as:

  • A. Persistent generalized lymphadenopathy
  • B. Sudden loss of weight, afternoon fever and general malaise
  • C. Tumors and opportunistic infections
  • D. Fever, weight loss, night sweats and diarrhea
Correct Answer: C

Rationale: Step 1: Classic full-blown AIDS presents with tumors and opportunistic infections due to severe immune system suppression.
Step 2: These manifestations occur when CD4 cell count drops significantly, leading to inability to fight infections.
Step 3: Persistent generalized lymphadenopathy (Choice A) can be seen in early HIV infection, not necessarily in full-blown AIDS.
Step 4: Sudden weight loss, fever, and malaise (Choice B) are non-specific symptoms seen in various conditions, not specific to AIDS.
Step 5: Fever, weight loss, night sweats, and diarrhea (Choice D) are common symptoms but lack the specificity of tumors and opportunistic infections seen in classic full-blown AIDS.

A patient verbalizes a low pain level of 2 out of 10 but exhibits extreme facial grimacing while moving around in bed. What is the nurse’s initial action in response to these observations?

  • A. Proceed to the next patient’s room to make rounds.
  • B. Determine the patient does not want any pain medicine.
  • C. Ask the patient about the facial grimacing with movement.
  • D. Administer the pain medication ordered for moderate to severe pain.
Correct Answer: C

Rationale: The correct initial action for the nurse is to ask the patient about the facial grimacing with movement (Choice C). This is important because the patient may not accurately express their pain level verbally. By addressing the discrepancy between the patient's verbal report and non-verbal cues, the nurse can gather more information to assess the patient's pain accurately. By directly communicating with the patient, the nurse can ensure that the appropriate interventions are provided.

Choice A is incorrect because it disregards the need to address the patient's pain assessment. Choice B assumes the patient's preference without further clarification. Choice D jumps to administering pain medication without fully assessing the situation, which could lead to inappropriate treatment.

The nurse inserts an intravenous (IV) catheter using the correct technique and following the recommended steps according to standards of care and hospital policy. Which type of implementation skill is the nurse using?

  • A. Cognitive
  • B. Interpersonal
  • C. Psychomotor
  • D. Judgmental
Correct Answer: C

Rationale: The correct answer is C: Psychomotor. The nurse is demonstrating psychomotor skills by inserting an IV catheter correctly. Psychomotor skills involve the ability to perform physical tasks effectively and efficiently. This skill requires coordination, dexterity, and precision. The other choices are incorrect because:
A: Cognitive skills involve thinking, analyzing, and problem-solving.
B: Interpersonal skills involve communication and interaction with others.
D: Judgmental skills involve critical thinking and decision-making.

Nurse Amy teaches a group of nursing students about the factors that cuses biliary cirrhosis. Which factor is associated with the condition?

  • A. acute viral hepatitis
  • B. alcohol hepatotoxicity
  • C. chronic biliary inflammation or obstruction
  • D. hepatic failure with prolonged venous hepatic congestion
Correct Answer: C

Rationale: The correct answer is C: chronic biliary inflammation or obstruction. Biliary cirrhosis is a condition characterized by scarring of the liver due to long-term damage to the bile ducts. Chronic biliary inflammation or obstruction can lead to the build-up of bile in the liver, causing damage over time. Acute viral hepatitis (choice A) typically does not directly cause biliary cirrhosis. Alcohol hepatotoxicity (choice B) is more commonly associated with alcoholic liver disease rather than biliary cirrhosis. Hepatic failure with prolonged venous hepatic congestion (choice D) may lead to liver cirrhosis, but it is not specific to biliary cirrhosis.

What instruction should the nurse give to then patient taking propan0lol (Inderal) for hypertension?

  • A. Have potassium level checked
  • B. Do not stop medication abruptly
  • C. Report any changes in appetite
  • D. Resume usual daily activities
Correct Answer: B

Rationale: The correct answer is B: Do not stop medication abruptly. Abruptly stopping propranolol can lead to rebound hypertension and potentially life-threatening complications. The nurse should emphasize the importance of gradual tapering under medical supervision to avoid adverse effects.

A: Having potassium levels checked is not directly related to propranolol use for hypertension management.
C: Changes in appetite are not specific to propranolol use and may not be a significant concern compared to abrupt cessation of the medication.
D: Resuming usual daily activities is important but not as crucial as the correct instruction to avoid abrupt discontinuation of propranolol.

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