Nursing Process Questions and Answers PDF

Correct Answer: C

Rationale: The correct answer is C because a lack of response to intradermal anergy testing suggests an inability to mount a normal delayed-type hypersensitivity response, indicating immunodeficiency. This could be due to conditions such as HIV, which impairs cell-mediated immunity. Choice A is incorrect because absence of reaction does not necessarily indicate lack of previous exposure to antigens. Choice B is incorrect as the absence of response doesn't confirm the presence of antibodies. Choice D is incorrect because anergy testing is not used to assess allergy, but rather to evaluate cell-mediated immunity.

Correct Answer: B

Rationale: The correct answer is B: Stage 2 hypertension. The patient's BP readings consistently fall within the range of 160-179 systolic or 100-109 diastolic, which aligns with the criteria for Stage 2 hypertension based on the current guidelines. This classification indicates a higher level of hypertension that requires prompt medical attention and intervention to reduce the risk of complications. Choices A, C, and D are incorrect because they do not correspond to the BP readings provided, falling outside the range for prehypertension, Stage 1 hypertension, and posthypertension.

Correct Answer: A

Rationale: The correct answer is A because taking a laxative like Senokot can affect the results of an IVP by altering bowel motility and potentially causing inaccurate imaging. Choice B is related to bladder sensation, which is not directly relevant to an IVP. Choice C indicates a possible allergic reaction to mussels, which is unrelated to the procedure. Choice D mentions headaches, which are also not directly linked to an IVP. In summary, only choice A directly impacts the accuracy of the IVP results, making it the most concerning statement for Nurse Aura.

Correct Answer: A

Rationale: The modified Trendelenburg position involves placing the client with their legs elevated higher than their head. This position promotes venous return to the heart, increasing preload and cardiac output, thereby leading to an increase in blood pressure. Elevating the legs helps to reduce peripheral edema and improve circulation. Therefore, the correct answer is A. Choice B is incorrect because the Trendelenburg position does not directly affect the respiratory rate. Choice C is incorrect as the position is not intended to increase heart rate but rather improve venous return. Choice D is also incorrect as the primary goal of the Trendelenburg position is not to decrease blood loss, although it may help in some cases by improving circulation.

Correct Answer: A

Rationale: The correct answer is A because an Ileostomy involves diverting the small intestine to an opening in the abdominal wall, so the urine will not be affected. The pouch collects waste from the small intestine. Nasogastric tube (B) is not typically required for an Ileostomy. Laparoscope (C) is used for visualizing the abdomen, not the bowel. Drinking liquids (D) so soon after surgery can be risky and is not recommended.