Foundations and Adult Health Nursing Study Guide Answers

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A patient presents with knee pain and swelling following a fall onto a flexed knee. Physical examination reveals a palpable effusion and tenderness along the joint line. McMurray's test elicits pain and clicking with passive knee flexion and internal rotation. Which condition is most likely?

  • A. Patellar tendinitis
  • B. Medial meniscus tear
  • C. Lateral collateral ligament (LCL) sprain
  • D. uadriceps tendon rupture
Correct Answer: B

Rationale: The presentation of knee pain and swelling following a fall onto a flexed knee, along with a palpable effusion and tenderness along the joint line, is highly suggestive of a meniscus injury. The McMurray's test specifically evaluates for meniscal tears. In this case, the presence of pain and clicking with passive knee flexion and internal rotation indicates a medial meniscus tear as the most likely diagnosis. Patellar tendinitis usually presents with anterior knee pain that is worsened by activities such as jumping or running. Lateral collateral ligament (LCL) sprain typically presents with lateral knee pain and instability. Quadriceps tendon rupture would present with significant weakness and inability to fully extend the knee, which is not described in this scenario.

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Which information about the nature of dengue fever the nurse should relay to the community?

  • A. It is always life threatening
  • B. It could be deadly but preventable
  • C. It could responds well to antibiotics
  • D. The incubation period is variable
Correct Answer: B

Rationale: The correct information about the nature of dengue fever that the nurse should relay to the community is that it could be deadly but preventable. Dengue fever is a viral infection spread by mosquitoes, particularly the Aedes aegypti mosquito. While many cases of dengue fever are mild, it can also lead to severe dengue, which can be life-threatening if not properly managed. However, preventive measures such as using mosquito repellent, wearing protective clothing, and eliminating breeding sites for mosquitoes can significantly reduce the risk of contracting dengue fever. Therefore, it is important for the community to be aware that while dengue fever can be deadly, it is also preventable with appropriate measures.

Which of the following dental conditions is characterized by the irreversible demineralization of the enamel and dentin, leading to cavitation and destruction of tooth structure?

  • A. Gingivitis
  • B. Dental caries
  • C. Periodontitis
  • D. Dental abscess
Correct Answer: B

Rationale: Dental caries, commonly known as tooth decay, is characterized by the irreversible demineralization of the enamel and dentin due to acids produced by bacterial activity. This process leads to cavitation and destruction of the tooth structure, ultimately resulting in the formation of a cavity. Gingivitis is inflammation of the gums, periodontitis is inflammation and infection of the supporting structures of the teeth (gums, bone, and ligaments), and a dental abscess is a collection of pus in the tissues surrounding the tooth, none of which are specifically related to the irreversible demineralization of enamel and dentin seen in dental caries.

What nursing diagnosis would be MOST appropriate for a client admitted with heart failure?

  • A. Risk for denial
  • B. Ineffective tissue perfusion
  • C. Impaired gas exchange
  • D. Acute pain
Correct Answer: B

Rationale: Heart failure is a condition in which the heart is unable to pump enough blood to meet the body's need for oxygen and nutrients. Ineffective tissue perfusion is a relevant nursing diagnosis for a client with heart failure because the heart's inability to effectively pump blood can lead to poor perfusion of tissues and organs, resulting in inadequate oxygen and nutrient delivery to cells. This can lead to symptoms such as fatigue, dyspnea, and edema, which are common in individuals with heart failure. By addressing ineffective tissue perfusion, nurses can focus on interventions to improve cardiac output and optimize tissue perfusion, ultimately improving the client's overall condition.

As a newly 1icensed nurse employed in a tertiary hospital, you are required to attend Continuing Professional Development (CPD) program. When the training program is for the enrichment of nurses in the hospital, it is called __________.

  • A. informal training program
  • B. formal education program
  • C. self-directed
  • D. In-service training program
Correct Answer: D

Rationale: In-service training programs are specifically designed to provide continuing education and professional development for employees within a particular organization, in this case, a hospital. These programs are tailored to meet the needs of the staff and enhance their skills and knowledge within their work environment. Since the CPD program in the tertiary hospital is aimed at enriching and supporting the growth of the nurses' knowledge and expertise within the hospital setting, it falls under the category of an in-service training program.

Applying multidisciplinary approach of patient care, which among the members of the multidisciplinary team that the nurse would MOST likely collaborate with when the patient is at risk of fall due to an impaired gait?

  • A. Podiatrist
  • B. Speech therapist
  • C. Physica l therapist
  • D. Nutritionist
Correct Answer: C

Rationale: When a patient is at risk of falls due to an impaired gait, a physical therapist would be the most appropriate member of the multidisciplinary team for the nurse to collaborate with. Physical therapists specialize in improving mobility, balance, and coordination through exercises, gait training, and other interventions. They can assess the patient's gait pattern, strength, and balance, and develop a personalized plan to address the impairments contributing to the fall risk. By working closely with a physical therapist, the nurse can help the patient improve their gait and reduce the risk of falls, ultimately promoting safety and independence.

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