foundation of nursing questions

foundation of nursing questions Related

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An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

  • A. The patient and family should be viewed as a single unit of care.
  • B. Persistent symptoms of terminal illness should not be treated.
  • C. Each member of the interdisciplinary team should develop an individual plan of care.
  • D. Terminally ill patients should die in the hospital whenever possible.
Correct Answer: A

Rationale: The correct answer is A: The patient and family should be viewed as a single unit of care. In hospice care, the focus is on providing holistic care not only to the patient but also to their family members. This approach recognizes that the patient's well-being is interconnected with that of their loved ones. By viewing the patient and family as a single unit of care, hospice providers can address not just the physical symptoms but also the emotional, social, and spiritual needs of both the patient and their family. This principle emphasizes the importance of supporting the patient and their family through the end-of-life journey.

Summary:
- Choice B is incorrect as hospice care aims to manage symptoms effectively to improve quality of life.
- Choice C is incorrect as hospice care typically involves a collaborative interdisciplinary team working towards common goals.
- Choice D is incorrect as hospice care often prioritizes providing end-of-life care in a comfortable setting preferred by the patient.

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What should the nurse recognize as evidence that the patient is recovering from preeclampsia?

  • A. 1+ protein in urine
  • B. 2+ pitting edema in lower extremities
  • C. Urine output >100 mL/hour
  • D. Deep tendon reflexes +2
Correct Answer: C

Rationale: Step 1: Increased urine output indicates improved kidney function, a key indicator of recovery from preeclampsia.
Step 2: Adequate urine output helps regulate blood pressure and reduce swelling.
Step 3: Consistent urine output >100 mL/hour signifies the kidneys are functioning properly.
Step 4: Therefore, C is the correct answer as it directly reflects recovery progress from preeclampsia.
Summary: A, B, and D are incorrect as they do not directly correlate with kidney function or recovery from preeclampsia.

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?

  • A. Lymphadenectomy
  • B. Needle biopsy
  • C. Open biopsy
  • D. Sentinel node biopsy
Correct Answer: D

Rationale: The correct answer is D: Sentinel node biopsy. This procedure involves identifying and removing the sentinel lymph node(s) which is the first lymph node(s) that cancer cells are likely to spread to from the primary tumor. This method helps determine if cancer has spread beyond the primary site without the need for a full axillary lymph node dissection. It is less invasive, has fewer side effects, and provides accurate staging information. Lymphadenectomy (A) refers to the removal of multiple lymph nodes, which is more extensive than necessary in this case. Needle biopsy (B) and open biopsy (C) are not specific to lymph node evaluation and do not provide accurate staging information for breast cancer.

A nurse is caring for an 8-year-old patient whois embarrassed about urinating in bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence?

  • A. “Set your alarm clock to wake you every 2 hours, so you can get up to void.”
  • B. “Line your bedding with plastic sheets to protect your mattress.”
  • C. “Drink your nightly glass of milk earlier in the evening.”
  • D. “Empty your bladder completely before going to bed.”
Correct Answer: C

Rationale: The correct answer is C: “Drink your nightly glass of milk earlier in the evening.” By suggesting the patient to drink milk earlier, it allows more time for the body to process and excrete the fluids before bedtime, reducing the likelihood of bedwetting. This intervention targets the root cause of the issue by addressing the timing of fluid intake.

Explanation for why the other choices are incorrect:
A: “Set your alarm clock to wake you every 2 hours, so you can get up to void.” This intervention disrupts the patient's sleep pattern and may not address the underlying cause of bedwetting.
B: “Line your bedding with plastic sheets to protect your mattress.” This intervention focuses on managing the consequences of bedwetting rather than preventing it.
D: “Empty your bladder completely before going to bed.” While important, this suggestion alone may not be sufficient to address the timing of fluid intake, which is crucial in reducing bedwetting frequency.

Which data found on a patient’s health history would place her at risk for an ectopic pregnancy?

  • A. Ovarian cyst 2 years ago
  • B. Recurrent pelvic infections
  • C. Use of oral contraceptives for 5 years
  • D. Heavy menstrual flow of 4 days’ duration
Correct Answer: B

Rationale: The correct answer is B: Recurrent pelvic infections. Pelvic infections can lead to scarring and blockage of the fallopian tubes, increasing the risk of ectopic pregnancy. Ovarian cysts and oral contraceptives are not directly linked to ectopic pregnancies. Heavy menstrual flow does not inherently increase the risk of ectopic pregnancy.

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply.

  • A. Abstaining from sexual intercourse for at least 14 days postprocedure
  • B. Wearing a scrotal support garment
  • C. Using sitz baths
  • D. Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours postprocedure
Correct Answer: A

Rationale: The correct answer is A: Abstaining from sexual intercourse for at least 14 days postprocedure. This is important to allow the surgical site to heal properly and reduce the risk of complications. Choice B, wearing a scrotal support garment, can provide comfort but does not directly enhance healing. Choice C, using sitz baths, may help with discomfort but may not specifically promote healing. Choice D, applying a heating pad intermittently, could potentially increase the risk of infection. Choice E, staying on bed rest for 48 to 72 hours postprocedure, is unnecessary and could lead to complications such as blood clots.

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