Foundations and Adult Health Nursing Test Bank

Foundations and Adult Health Nursing Test Bank Related

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A patient presents with chest pain that occurs during heavy lifting or physical exertion and is relieved by rest. An electrocardiogram (ECG) may show transient ST-segment depression. Which cardiovascular disorder is most likely responsible for these symptoms?

  • A. Stable angina
  • B. Unstable angina
  • C. Acute myocardial infarction
  • D. Prinzmetal's angina
Correct Answer: A

Rationale: The given patient's symptoms of chest pain that occurs during heavy lifting or physical exertion and is relieved by rest are consistent with stable angina. Stable angina is characterized by predictable chest pain that occurs with exertion and is typically relieved by rest or nitroglycerin. The transient ST-segment depression on ECG is also a common finding in patients with stable angina, which reflects myocardial ischemia during episodes of chest pain triggered by exertion. In contrast, unstable angina is characterized by chest pain at rest or with minimal exertion that is of increasing frequency, severity, or duration. Acute myocardial infarction is associated with persistent ST-segment elevation or new Q-waves on ECG, and Prinzmetal's angina is characterized by chest pain at rest due to coronary artery spasm rather than exertion.

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When Nurse Ace suubitted a report to the physician that she committed an error in medication. This is an example of

  • A. Responsibility
  • B. Commitment
  • C. Accountability
  • D. Delegation
Correct Answer: C

Rationale: Nurse Ace submitting a report to the physician about committing an error in medication demonstrates accountability. Accountability in healthcare refers to the responsibility of individuals to answer for their actions, decisions, and behaviors in the professional setting. By taking ownership of the mistake and informing the physician, Nurse Ace is showing accountability for her actions, ensuring that patient safety remains a priority. Compliance with reporting errors is essential for quality improvement and patient safety in healthcare settings.

A patient is prescribed a benzodiazepine for the management of anxiety. Which instruction should the nurse include in patient education about benzodiazepine therapy?

  • A. "Take the medication with grapefruit juice for enhanced absorption."
  • B. "Avoid consuming alcohol while on benzodiazepine therapy."
  • C. "Take the medication on an empty stomach for better effectiveness."
  • D. "Discontinue the medication abruptly if you experience side effects."
Correct Answer: B

Rationale: Consuming alcohol while on benzodiazepine therapy can increase the central nervous system depressant effects of benzodiazepines, leading to excessive sedation, respiratory depression, and even overdose. It is important for patients to avoid alcohol to prevent these potential dangerous interactions and to ensure the safe and effective use of their medication.

Charting are important documents that are used in court proceedings a Nurse Chona should take note that the following entry recorded would be MOST defensible in court?

  • A. Large bruises on thigh upon assessment.
  • B. Patient fell out of bed when reaching out for medication.
  • C. Burn on the back area observed upon auscultation.
  • D. Patient drunk when seen in the Emergency Room.
Correct Answer: A

Rationale: Of the options provided, documenting objective, observable findings such as large bruises on the thigh upon assessment is the most defensible entry in court. This type of entry is based on the nurse's direct observation and assessment of the patient's physical condition, which can be corroborated by other healthcare providers or evidence. It provides clear, factual information without making assumptions or subjective judgments. In court, this type of documentation can help support the nurse's credibility and reliability as a witness.

A postpartum client presents with sudden chest pain, dyspnea, and tachycardia. Which nursing action should be prioritized?

  • A. Elevating the head of the bed
  • B. Providing supplemental oxygen therapy
  • C. Administering analgesics for pain relief
  • D. Notifying the healthcare provider immediately
Correct Answer: D

Rationale: Sudden chest pain, dyspnea, and tachycardia in a postpartum client can be indicative of serious conditions such as pulmonary embolism or myocardial infarction. These conditions are emergencies that require immediate medical attention. Notifying the healthcare provider immediately is the priority to ensure prompt evaluation and intervention to address the potential life-threatening situation. While other nursing interventions such as elevating the head of the bed, providing supplemental oxygen therapy, and administering analgesics may be necessary, they should be done after notifying the healthcare provider to ensure appropriate management of the underlying cause.

He plans to use a Likert Scale to determine:

  • A. compliance to expected standards
  • B. level of satisfaction
  • C. degree of agreement and disagreement
  • D. degree of acceptance
Correct Answer: C

Rationale: A Likert Scale is typically used to measure the degree of agreement or disagreement with a set of statements or questions. Respondents are asked to indicate their level of agreement or disagreement using a scale that ranges from, for example, "strongly agree" to "strongly disagree". This makes it a suitable tool for assessing the degree of agreement and disagreement among individuals on various topics or statements. While a Likert Scale can potentially measure other constructs such as satisfaction or acceptance, its primary purpose and most common application involve determining the degree of agreement and disagreement.

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