Adult Health Nursing Test Banks

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A patient receiving palliative care for end-stage liver disease experiences severe pruritus. What intervention should the palliative nurse prioritize to address the patient's symptoms?

  • A. Administer antihistamine medications for itch relief.
  • B. Recommend topical corticosteroid creams to alleviate itching.
  • C. Encourage the patient to avoid hot showers or baths to prevent exacerbation of pruritus.
  • D. Prescribe cholestyramine or other bile acid sequestrants for pruritus management.
Correct Answer: D

Rationale: In end-stage liver disease, pruritus (itching) can be a distressing symptom caused by the accumulation of bile salts in the skin due to impaired liver function. Cholestyramine and other bile acid sequestrants are the primary treatment for managing pruritus in these patients. These medications bind to the bile salts in the intestine, preventing their reabsorption and reducing the itching symptoms. Antihistamines may not be as effective for this type of pruritus since it is not histamine-mediated. Topical corticosteroids are generally not recommended for long-term use in liver disease due to the risk of systemic absorption and adverse effects. Avoiding hot showers or baths may provide some temporary relief but is not a definitive treatment. Therefore, prioritizing the prescription of cholestyramine or bile acid sequestrants would be the most appropriate intervention to address the severe pruritus in a patient with end-stage liver disease

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Nurse Maris oftentimes encounter barriers. Select a barrier to goal setting between the nurse and the family.

  • A. Eeducational attainment
  • B. Nature of employment
  • C. Failure of family to perceive existence of problem
  • D. Socio economic status
Correct Answer: C

Rationale: The barrier to goal setting between the nurse and the family in this scenario is the failure of the family to perceive the existence of the problem. Goal setting in healthcare generally requires mutual agreement and understanding between the healthcare provider (nurse) and the patient/family. If the family does not perceive that there is an existing problem that needs to be addressed, there will likely be resistance or lack of motivation to set goals and work towards resolving the issue. This barrier can hinder effective communication, collaboration, and ultimately, the successful achievement of healthcare goals. It is important for the nurse to address this barrier through education, communication, and building trust to ensure that all parties are on the same page and actively participate in goal setting and care planning.

Which of the following is the preventive measure to osteoporosis development

  • A. Iron rich food
  • B. Daily jogging
  • C. Calcium rich food and supplement
  • D. Vigorous exercise
Correct Answer: C

Rationale: Calcium is essential for maintaining strong and healthy bones. Osteoporosis is a condition characterized by weakened bones, making them more prone to fractures. Consuming calcium-rich foods such as dairy products, leafy greens, and fortified foods can help prevent osteoporosis development. Additionally, incorporating calcium supplements under the guidance of a healthcare provider can further support bone health and reduce the risk of osteoporosis. Regular intake of adequate calcium is considered a crucial preventive measure for osteoporosis.

In handling all information about the famiilies in the community, which of the following principles should the nurse consider ethical?

  • A. Confidentialty
  • B. Justice
  • C. Fair treatment
  • D. Beneficence
Correct Answer: A

Rationale: When handling information about families in the community, the nurse should consider the principle of confidentiality as ethical. Confidentiality refers to the obligation of healthcare providers to safeguard the privacy of patient information. By maintaining confidentiality, the nurse upholds trust and respect in the nurse-family relationship. This principle ensures that sensitive information shared by families is kept secure and not disclosed without permission, thus respecting their autonomy and promoting open communication in healthcare settings.

When the nurse placed the patient in restraints before using other methods of intervention, she/he violated the patient's rights to ______.

  • A. receive confidential and respectful care
  • B. provide informed consent
  • C. receive treatment in the least restrictive environment
  • D. refuse treatment
Correct Answer: C

Rationale: Placing a patient in restraints before utilizing other less restrictive interventions violates the patient's right to receive treatment in the least restrictive environment. Restraints should be used as a last resort when all other options have been exhausted, as they can be restrictive to the patient's movement and freedom. Patients have the right to be treated in a manner that minimizes limitations on their personal freedom and autonomy. Restraints should only be utilized when absolutely necessary for the safety of the patient or others.

The physician ordered sonography. The nurse informs the ultrasound unit in charge and prepares the patient for the procedure. The patient asks the importance of the procedure, the nurse CORRECT response is________.

  • A. to determine diameters of the fetal skull
  • B. increase sensitivity for common bile duct of the fetus
  • C. useful to a visualized cystic duct of the fetus
  • D. to assess fetus' well-being
Correct Answer: D

Rationale: Sonography, also known as ultrasound, is a non-invasive imaging technique that uses high-frequency sound waves to create images of structures inside the body. In the context of a patient who is pregnant, sonography is commonly used to assess the well-being of the fetus. It allows healthcare providers to monitor the growth and development of the fetus, evaluate the placenta, amniotic fluid levels, and detect any abnormalities that may be present.

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