Pharmacology and the Nursing Process Test Bank

Correct Answer: B

Rationale: The correct answer is B: Monitor temperature every 4hrs. This is crucial in detecting signs of urinary tract infection as fever is a common symptom. Monitoring temperature regularly allows for early detection and appropriate intervention. A: Encouraging the client to breathe deeply and cough every 2hrs is a measure to prevent respiratory complications postoperatively, not related to UTI detection. C: Splinting the incision when repositioning the client is important for wound care, not for detecting UTI. D: Irrigating tubes as ordered is a specific intervention for tube care, not for monitoring UTI symptoms.

Correct Answer: A

Rationale: The correct answer is A: A urine output of 400 ml in 8 hours indicates a fluid and electrolyte imbalance induced by chemotherapy. Chemotherapy can cause renal damage, leading to decreased urine output. This can result in fluid retention and electrolyte imbalances. Choice B is incorrect because a serum potassium level of 3.6 mEq/L is within the normal range. Choice C is incorrect as the blood pressure readings provided are within the normal range. Choice D is incorrect as dry oral mucous membranes and cracked lips are more indicative of dehydration rather than a fluid and electrolyte imbalance induced by chemotherapy.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Providing oral care does not directly address fluid balance or hydration status. 2. Oral care focuses on maintaining oral hygiene and preventing infections. 3. Choices A, B, and D all involve fluid intake to address dehydration. 4. Offering large amounts of fluid, enteral or parenteral fluids, and small volumes at frequent intervals all aim to correct the patient's condition by replenishing lost fluids. Summary: Choice C is incorrect because oral care does not directly address the patient's dehydration. Choices A, B, and D are better options as they focus on fluid replacement to correct the patient's condition.

Correct Answer: B

Rationale: The correct answer is B: Hemorrhage. The nurse manager would intervene because hemorrhage is a life-threatening condition requiring immediate attention. Wandering (A), urinary retention (C), and impaired swallowing (D) are important assessments but do not pose the same level of immediate risk as hemorrhage. The nurse manager would prioritize addressing the hemorrhage to ensure the patient's safety and well-being.

Correct Answer: B

Rationale: The correct answer is B because the right side weakness indicates a lesion in the left hemisphere of the brain. The brain's motor functions are contralaterally controlled, meaning the left hemisphere controls the right side of the body. Therefore, a right-sided weakness suggests a lesion in the left hemisphere. The other choices are incorrect because expressive aphasia is associated with left hemisphere lesions, judgment of distance and proprioception are more related to parietal lobe lesions, and orientation to time and space is not directly linked to right-sided weakness.