Concepts and Cases in Nursing Ethics Test Bank

Concepts and Cases in Nursing Ethics Test Bank Related

Review Concepts and Cases in Nursing Ethics Test Bank related questions and content

The nurse is caring for an adult client who was diagnosed with a congenital heart defect as a child, which was later repaired with surgery. Which common complication of a heart defect should the nurse monitor that the client may still be at risk for?

  • A. Deep vein thrombosis
  • B. Endocarditis
  • C. Atherosclerosis
  • D. Shock
Correct Answer: B

Rationale: Endocarditis is a common complication that individuals with repaired congenital heart defects may still be at risk for. Endocarditis is an infection of the inner lining of the heart chambers and valves. The altered structure of the heart tissue from the previous defect and surgery can create an increased risk for bacterial growth and infection. Patients with a history of congenital heart defects should be monitored for signs and symptoms of endocarditis, such as fever, fatigue, new heart murmurs, and evidence of systemic embolization. Prophylactic antibiotics before certain dental and surgical procedures may be recommended to prevent endocarditis in this population. Therefore, the nurse should be vigilant in monitoring for any symptoms suggestive of endocarditis in this client.

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After a stroke, sensory-perceptual changes increase the client's risk for what?

  • A. Aspiration
  • B. Injury
  • C. Bleeding
  • D. Infection
Correct Answer: B

Rationale: After a stroke, sensory-perceptual changes such as impaired proprioception, altered sensation, and decreased awareness of the affected side can increase the client's risk for injury. These changes can result in difficulties with balance, coordination, and spatial awareness, making the individual more prone to falls and accidents. It is important to implement safety measures and interventions to minimize the risk of injury in these clients, such as providing a structured environment, using assistive devices, and encouraging regular monitoring and assistance as needed.

The nurse evaluates teaching provided to a patient with a newly created ileal diversion with a continent reservoir. Which patient behavior indicates teaching has been effective?

  • A. Demonstrates care for the collection device
  • B. Demonstrates self-catheterization of the stoma
  • C. Identifies factors contributing to the risk for bladder cancer
  • D. States the importance of promptly reporting cloudy urine to the physician
Correct Answer: A

Rationale: In a patient with a newly created ileal diversion with a continent reservoir, demonstrating care for the collection device signifies that the patient has understood the importance of maintaining hygiene and proper management of the device. This behavior indicates that the teaching provided by the nurse has been effective in helping the patient take care of the diversion and prevent complications such as infection or skin irritation. Understanding how to care for the collection device is crucial for the patient's overall well-being and quality of life with the continent reservoir.

The nurse is caring for a client with congestive heart failure (CHF) who frequently wakes during the night frightened and short of breath. Based on this data, what is the client experiencing?

  • A. Cardiomyopathy
  • B. Paroxysmal nocturnal dyspnea
  • C. High-output failure
  • D. Multisystem heart failure
Correct Answer: B

Rationale: Paroxysmal nocturnal dyspnea is a symptom commonly seen in patients with congestive heart failure (CHF). It is characterized by sudden awakening from sleep due to difficulty breathing and feeling of suffocation. This occurs because when the patient lies down, the redistribution of fluid in the body leads to increased fluid in the lungs, causing difficulty in breathing. Patients with CHF often experience worsening of symptoms at night, including paroxysmal nocturnal dyspnea, due to the shift in fluid dynamics in a supine position. Therefore, the client in this scenario is likely experiencing paroxysmal nocturnal dyspnea, a classic symptom of heart failure exacerbation.

A patient has developed a paralytic ileus following recent abdominal surgery. What is the most important nursing action when caring for this patient?

  • A. Monitor bowel sounds every hour
  • B. Maintain the patient on strict bed rest
  • C. Ensure the nasogastric tube is functioning
  • D. Ensure that the patient is given a clear liquid diet
Correct Answer: C

Rationale: Ensuring that the nasogastric tube is functioning is the most important nursing action when caring for a patient with a paralytic ileus. A paralytic ileus is a condition where there is a temporary paralysis of the intestine, leading to a lack of bowel motility. This can result in a buildup of gas and fluids in the intestines, causing abdominal distension, pain, and potential complications.

The nurse hears a grating sound while assessing the range of motion of a patient’s hip. How should the nurse document this finding?

  • A. Crackles
  • B. Arthritis
  • C. Synovitis
  • D. Crepitation
Correct Answer: D

Rationale: Crepitation refers to a grating sound or sensation that occurs when there is rubbing together of the roughened articular surfaces of bones within a joint. It is commonly associated with conditions such as osteoarthritis or joint injury. Therefore, if the nurse hears a grating sound while assessing the range of motion of a patient's hip, the appropriate documentation of this finding would be crepitation.

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