Adult Health Nursing Answer Key

Adult Health Nursing Answer Key Related

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A patient receiving palliative care for end-stage heart failure experiences severe fatigue and limited mobility. What intervention should the palliative nurse prioritize to promote the patient's comfort and quality of life?

  • A. Recommend initiating physical therapy to improve mobility and strength.
  • B. Encourage the patient to conserve energy and avoid unnecessary activities.
  • C. Prescribe stimulant medications to alleviate fatigue and increase energy levels.
  • D. Refer the patient to a nutritionist for dietary modifications to boost energy.
Correct Answer: B

Rationale: In this scenario, the palliative nurse should prioritize encouraging the patient to conserve energy and avoid unnecessary activities (Option B). End-stage heart failure can lead to severe fatigue and limited mobility, making it essential for the patient to conserve energy to prevent exacerbating symptoms and improve quality of life. Engaging in physical therapy (Option A) may not be suitable for a patient experiencing severe fatigue, as it can further drain energy reserves. Prescribing stimulant medications (Option C) may have limited effectiveness and potential side effects. Referring the patient to a nutritionist for dietary modifications (Option D) is important for overall health but may not directly address the immediate comfort and quality of life concerns related to fatigue and limited mobility. Helping the patient prioritize energy conservation will allow them to use their limited energy for essential activities, leading to a more comfortable and fulfilling experience while receiving palliative care for end-stage heart failure.

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When one has a Cushing disease the focal structure affected is the _______.

  • A. hypothalamus
  • B. pituitary gland
  • C. adrenal gland
  • D. para thyroid gland
Correct Answer: B

Rationale: When one has Cushing's disease, the focal structure affected is the pituitary gland. Cushing's disease is caused by the overproduction of adrenocorticotropic hormone (ACTH) by the pituitary gland. This excess ACTH stimulates the adrenal glands to produce too much cortisol, leading to the symptoms associated with Cushing's disease. Therefore, the primary issue originates in the pituitary gland, not the other structures mentioned in the question.

You also emphasized that, "Communication must be culturally competent to be effective". Which of the following BEST reflects these statements?

  • A. Listen actively to what is said
  • B. Reflect on the meaning of the message
  • C. Use simple, direct words
  • D. Provide an appropriate environment
Correct Answer: A

Rationale: Actively listening to what is being said is a key component of effective communication that is culturally competent. By listening attentively and showing genuine interest in understanding the perspective of the speaker, you are better able to grasp the nuances of their communication style, values, and beliefs. This allows for more effective communication that takes into consideration the cultural context of the person you are communicating with. Developing active listening skills helps in building rapport, fostering understanding, and promoting mutual respect in cross-cultural interactions.

A patient with a history of myocardial infarction is prescribed atorvastatin for lipid-lowering therapy. Which parameter should the nurse monitor closely during atorvastatin therapy?

  • A. Serum potassium levels
  • B. Liver function tests
  • C. Blood glucose levels
  • D. Serum sodium levels
Correct Answer: B

Rationale: Atorvastatin is a medication commonly used for lipid-lowering therapy to reduce cholesterol levels and decrease the risk of cardiovascular events. However, one of the potential side effects of statin medications such as atorvastatin is liver injury. Therefore, monitoring liver function tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, is crucial during atorvastatin therapy.

Which of the following is the initial teachinggiven to the patient with ALS having problems in communication?

  • A. Referring the client to a speech therapist
  • B. Documenting any change in the elimination functions
  • C. Use of pre-signals before the loss of speech
  • D. Continue to use therapeutic communication technique
Correct Answer: C

Rationale: In ALS (Amyotrophic Lateral Sclerosis), communication difficulties may occur as the disease progresses and affects the muscles responsible for speech. It is crucial to initiate early measures to assist the patient in communicating effectively. Using pre-signals before the loss of speech can be helpful in maintaining communication with the patient. These pre-signals can include gestures, writing tools, communication boards, or technology-assisted communication devices. By introducing and practicing these pre-signals early on, the patient can adapt and utilize alternative communication methods before the loss of speech becomes more challenging. This proactive approach can significantly improve the patient's ability to communicate and maintain a sense of connection with others.

A nurse is caring for a patient who is refusing a prescribed treatment due to cultural beliefs. What action should the nurse take to address the patient's refusal?

  • A. Ignore the patient's cultural beliefs and insist on treatment compliance
  • B. Provide education and information to help the patient understand the treatment benefits
  • C. Dismiss the patient's concerns and consult with the healthcare provider to override their decision
  • D. Respect the patient's autonomy and collaborate on alternative treatment options
Correct Answer: D

Rationale: The nurse should respect the patient's autonomy and collaborate on alternative treatment options. It is essential to honor the patient's cultural beliefs and preferences while also seeking to find a solution that aligns with the healthcare provider's recommendations. By working together with the patient to explore alternative treatment options that are acceptable within the patient's cultural framework, the nurse can promote patient-centered care and foster a trusting relationship with the patient.Ignoring or dismissing the patient's cultural beliefs can lead to decreased patient adherence and trust in the healthcare provider. Providing education and information to help the patient understand the treatment benefits is important, but it should be done in a way that respects the patient's autonomy and cultural perspective.

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