Nursing Process Practice Questions Quizlet

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Which of the ff is a reason for providing early discharge instructions and making arrangements for home care for clients undergoing mastectomy?

  • A. The adverse effect of mastectomy are immediate
  • B. The wound of the surgery is highly contagious and the client should exercise isolation precautions immediately after the procedure
  • C. Most clients are not hospitalized long after a mastectomy
  • D. The suicidal tendencies in the women undergoing a mastectomy are high
Correct Answer: C

Rationale: Step 1: Most clients are not hospitalized long after a mastectomy - Correct. This is because mastectomy is often performed as an outpatient procedure, and clients are discharged home shortly after surgery.
Step 2: The adverse effects of mastectomy are not immediate - Incorrect. Adverse effects may occur post-surgery, but early discharge is not solely due to immediate adverse effects.
Step 3: The wound of the surgery is not highly contagious - Incorrect. Mastectomy wounds are not contagious, and isolation precautions are not necessary.
Step 4: Suicidal tendencies in women undergoing mastectomy are not high - Incorrect. While emotional support is crucial, early discharge is not primarily due to suicidal tendencies.

Summary: Choice C is correct because mastectomy clients are typically not hospitalized long, making early discharge instructions and home care arrangements necessary. Choices A, B, and D are incorrect as they do not directly relate to the primary reason for early discharge and home care planning.

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A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide?

  • A. “Administer desmopressin while the suspension is cold.”
  • B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
  • C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
  • D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”
Correct Answer: C

Rationale: The correct answer is C: “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”

Rationale:
1. Desmopressin is available in intranasal form for diabetes insipidus.
2. Nasal discharge or blockage may prevent proper absorption of the medication.
3. Instructing the client about this potential issue ensures optimal drug effectiveness.

Summary:
A: Incorrect. Temperature of desmopressin suspension doesn't affect its efficacy.
B: Incorrect. A medical identification bracelet is necessary for chronic conditions like diabetes insipidus.
D: Incorrect. Monitoring fluid intake and output is crucial when taking desmopressin.

The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

  • A. Exposure to sunlight will help control skin rashes.
  • B. There are no activity limitations between flare-ups.
  • C. Monitor body temperature
  • D. Corticosteroids may be stopped when symptoms are relieved.
Correct Answer: C

Rationale: Rationale:
C: Monitoring body temperature is essential for early detection of infection or fever, which can indicate disease exacerbation in SLE clients.
A: Exposure to sunlight can worsen SLE symptoms due to photosensitivity.
B: Activity limitations are crucial to prevent flare-ups and reduce disease progression in SLE.
D: Corticosteroids should not be stopped abruptly without healthcare provider guidance to prevent symptom recurrence and adrenal insufficiency.

The nurse recognizes that the major early problem for Mr. Gabatan will be:

  • A. Bladder control
  • B. Quadriceps setting
  • C. Client education
  • D. Use of aids for ambulation
Correct Answer: B

Rationale: The correct answer is B: Quadriceps setting. After surgery, quadriceps setting exercises are crucial for preventing muscle atrophy and maintaining joint mobility. Bladder control (A) is important but typically not the major early problem. Client education (C) and use of aids for ambulation (D) are important aspects of care but not the primary concern immediately post-surgery. Quadriceps setting helps prevent complications and promote early mobility.

A client with cancer that has metastazised to the liver is started on chemotherapy- His physician has specified divided doses of the antimetabolite. The client asks why he could take the drug in divided doses. The appropriate response is:

  • A. " There really is no reason your doctor just wrote the orders that way."
  • B. "This schedule will reduce the side effect of the drug."
  • C. "Divided doses produce greater cytotoxic effects on the diseased cells."
  • D. "Because these drugs prevent cell division, they are more effective in divided doses,"
Correct Answer: C

Rationale: The correct answer is C: "Divided doses produce greater cytotoxic effects on the diseased cells." Dividing the doses of the antimetabolite allows for more consistent levels of the drug in the bloodstream, ensuring sustained exposure to the cancer cells. This continuous exposure enhances the drug's cytotoxic effects, increasing its efficacy in targeting and destroying the diseased cells. Options A and B provide vague or incorrect information, while option D is misleading as antimetabolites do not prevent cell division, but rather disrupt DNA synthesis.

The NAP states that was busy and had not had a chance to tell the nurse yet. The patient begins to complain of feeling dizzy and light-headed. The blood pressure is rechecked and it has dropped even lower. In which phase of the nursing process did the nurse first make an error? NursingStoreRN

  • A. Assessment
  • B. Diagnosis
  • C. Implementation
  • D. Evaluation
Correct Answer: A

Rationale: The correct answer is A: Assessment. The nurse made an error in the assessment phase by not communicating the patient's condition promptly. Assessment involves collecting data and recognizing changes in the patient's condition. By not informing the nurse about feeling dizzy and light-headed, the nurse missed crucial information that could have indicated a deteriorating condition. The other choices are incorrect because: B: Diagnosis comes after assessment and involves analyzing data to identify the patient's problems. C: Implementation is the phase where nursing interventions are carried out based on the diagnosis. D: Evaluation is the final phase where the nurse assesses the effectiveness of interventions and outcomes.

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