Adult Health Nursing Test Bank

Adult Health Nursing Test Bank Related

Review Adult Health Nursing Test Bank related questions and content

Which of the following situations will the nurse consider as risks factors for complicated grief?

  • A. Childbirth, marriage and divorce
  • B. Death of a spouse, child, death by suicide
  • C. Inadequate perception of the grieving process
  • D. Inadequate support and old age
Correct Answer: B

Rationale: The correct answer is B because the death of a spouse, child, or death by suicide are all significant losses that can lead to complicated grief due to the intensity of emotions and the disruption of daily life. These experiences can result in prolonged and severe grieving processes that may require professional intervention.

Explanation for other choices:
A: Childbirth, marriage, and divorce are not typically considered risk factors for complicated grief as they are more commonly associated with expected life events that may involve grief but not necessarily lead to complicated grief.
C: Inadequate perception of the grieving process may contribute to difficulties in coping with grief but is not a direct risk factor for complicated grief.
D: While inadequate support can impact the grieving process, and old age may present unique challenges, they are not specific risk factors for complicated grief compared to the profound loss experienced in choice B.

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Sensitivity is the ability of a screening test to accurately identify what aspect of the screening?

  • A. Persons with symptoms of the disease.
  • B. Persons who have the disease.
  • C. Persons who do not have the disease.
  • D. Persons who now have a diagnosis of disease.
Correct Answer: B

Rationale: The correct answer is B: Persons who have the disease. Sensitivity measures how well a test correctly identifies individuals who have the disease (true positives). It is essential in determining the test's ability to detect the presence of the disease accurately. Choices A, C, and D are incorrect because sensitivity focuses on correctly identifying individuals who have the disease, not those with symptoms, those without the disease, or those with a diagnosis of the disease.

What type of sampling wills Nurse Sandy adopts 11 when every third (3rd) patients with MI are selected after a random start?

  • A. Simple random
  • B. Stratified
  • C. Systematic
  • D. Cluster
Correct Answer: C

Rationale: The correct answer is C: Systematic sampling. Nurse Sandy is adopting systematic sampling by selecting every third patient with MI after a random start. This method ensures equal chance of selection for each patient and maintains randomness. In contrast, simple random sampling (A) entails each patient having an equal chance of being selected independently. Stratified sampling (B) divides patients into groups based on certain characteristics, which is not the case here. Cluster sampling (D) involves grouping patients and selecting entire groups, which is different from the individual selection in this scenario.

Which of the following cell types is primarily responsible for presenting antigens to T cells during the immune response?

  • A. B cells
  • B. Natural killer (NK) cells
  • C. Macrophages
  • D. Eosinophils
Correct Answer: C

Rationale: The correct answer is C: Macrophages. Macrophages are antigen-presenting cells that engulf pathogens and present their antigens to T cells, initiating an immune response. They express major histocompatibility complex (MHC) molecules necessary for T cell recognition. B cells also present antigens but primarily to B cells for antibody production. NK cells are involved in killing infected cells, not antigen presentation. Eosinophils are mainly involved in allergic responses and defense against parasites, not antigen presentation.

The physician inserted a chest tube drainage to Mr. Alda in order to help re-expand the lungs. Which of the following should you prepare FIRST as a nurse in case of emergency when the tube is accidentally disconnected?

  • A. sterile clamps
  • B. Sterile dressing.
  • C. Another chest tube
  • D. A bottle of sterile water.
Correct Answer: A

Rationale: Correct Answer: A - sterile clamps

Rationale:
1. **Immediate action**: Sterile clamps are essential to clamp the chest tube to prevent air from entering the pleural space.
2. **Prevent lung collapse**: Clamping the tube will prevent lung collapse and maintain positive pressure in the pleural space.
3. **Buy time**: By clamping the tube, you buy time to properly reattach the tube or secure it with a new connection.
4. **Safety**: Sterile clamps are a quick and effective solution to prevent a potentially life-threatening situation.

Summary of other choices:
B: Sterile dressing - Not the first priority as the immediate concern is preventing air from entering the pleural space.
C: Another chest tube - Not necessary initially as clamping can buy time to reattach the disconnected tube.
D: A bottle of sterile water - Not needed for emergency management of a disconnected chest tube.

A postpartum client presents with persistent, severe perineal pain and swelling following a vaginal delivery. On assessment, the nurse notes ecchymosis and tenderness of the perineum. Which nursing action is most appropriate?

  • A. Applying ice packs to the perineum for pain relief
  • B. Encouraging the client to sit on a donut cushion
  • C. Notifying the healthcare provider immediately
  • D. Administering additional analgesic medication
Correct Answer: C

Rationale: The most appropriate nursing action in this situation is to notify the healthcare provider immediately. The client presenting with persistent, severe perineal pain and swelling, along with ecchymosis and tenderness of the perineum, could be indicative of complications such as a perineal hematoma. A perineal hematoma is a collection of blood in the perineal tissues and can be a serious postpartum complication requiring prompt medical attention. Therefore, it is crucial to alert the healthcare provider so that appropriate assessment, management, and treatment can be initiated promptly. Applying ice packs or encouraging the client to sit on a donut cushion may not be sufficient in this situation, and administering additional analgesic medication should be done only after the healthcare provider has assessed and determined the cause of the symptoms.

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