Concepts for Nursing Practice Test Bank

Correct Answer: A

Rationale: 1. Tachycardia: Disseminated intravascular coagulation (DIC) can lead to widespread clotting within the blood vessels, which can result in tissue ischemia and subsequent compensatory mechanisms such as tachycardia to increase cardiac output and maintain perfusion.

Correct Answer: B

Rationale: Option B, "Demonstrates care of the vascular access device for dialysis," indicates that the patient understands how to care for their vascular access device, which is important for receiving dialysis treatment. This action shows adequate comprehension and competency in managing this aspect of their care. Therefore, additional teaching is not necessary in this area. On the other hand, options A, C, and D present actions that may require further clarification or reinforcement in the teaching provided to the patient with acute glomerulonephritis.

Correct Answer: A

Rationale: Impaired Gas Exchange is the nursing diagnosis that should take the highest priority for implementing client education in a client with chronic obstructive pulmonary disease (COPD). Since COPD directly affects the ability of the lungs to take in oxygen and eliminate carbon dioxide, impaired gas exchange is a critical concern for these patients. By educating the client on proper breathing techniques, medication adherence, smoking cessation, and environmental triggers, the nurse can help in improving gas exchange and overall respiratory function. Addressing Impaired Gas Exchange as a priority can significantly impact the client's quality of life and prevent respiratory complications.

Correct Answer: B

Rationale: Calcium is essential in bone healing as it is a major component of bone tissue. Adequate calcium intake is crucial for maintaining bone density and strength, which is particularly important during the healing process of a fractured bone. Calcium plays a key role in the mineralization of bone tissue, helping in the formation of new bone and repair of the fractured area. Therefore, teaching the patient about the importance of sufficient calcium intake is vital for promoting bone healing and recovery.

Correct Answer: D

Rationale: Hemophilia is a genetic disorder that impairs the blood's ability to clot properly, leading to prolonged bleeding. This makes individuals with hemophilia particularly susceptible to hemorrhagic shock, which is a type of distributive shock. Distributive shock occurs when there is widespread vasodilation and increased vascular permeability, leading to inadequate tissue perfusion and oxygen delivery. In the case of hemophilia, excessive bleeding can result in a significant loss of blood volume and impaired circulation, eventually leading to distributive shock due to the body's inability to maintain adequate perfusion to vital organs. Therefore, individuals with hemophilia are at an increased risk of developing distributive shock, specifically hemorrhagic shock, if they experience severe bleeding events.