Pharmacology and the Nursing Process Test Bank

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: D

Rationale: The correct answer is D because educating the client about the disease process and its limitations is crucial in managing Chronic Fatigue Syndrome (CFS). By understanding the disease, the client can make informed decisions regarding their lifestyle, activities, and self-care. This empowers the client to manage symptoms effectively and prevent exacerbations. Choice A is not the most important factor as simply avoiding aggravating the disease does not address the overall management of CFS. Choice B focuses solely on drug therapy, which is only one aspect of the client's management and may not provide significant improvement for all clients with CFS. Choice C, altering diet and environment, can be helpful but may not be the most important factor as understanding the disease process and limitations is essential for long-term management and quality of life.

Correct Answer: C

Rationale: The correct answer is C: Call the physician. In this scenario, the sudden severe headache and nasal congestion along with flushed skin and goosebumps suggest autonomic dysreflexia, a medical emergency in spinal cord injury at or above T6. The nurse should immediately call the physician to address this potentially life-threatening situation. Raising the client's head (A) may worsen the condition, placing the client on a firm mattress (B) is not a priority, and administering an analgesic (D) without addressing the underlying cause could lead to further complications. The priority is to identify and address the cause of autonomic dysreflexia promptly.

Correct Answer: A

Rationale: The correct answer is A. Blood type A is considered the rarest because it is less common in the general population compared to other blood types. The rarity of blood type A is due to the combination of genetic factors that determine blood type. In contrast, blood types B and O are more common in the population, while blood type AB is considered the universal recipient type and is therefore not the rarest. Blood type A is less prevalent, making it the correct answer in this scenario.

Correct Answer: B

Rationale: The correct answer is B because nurse-initiated interventions involve autonomous actions based on clinical judgment to achieve client outcomes. Nurses assess, plan, and implement care independently. Choice A involves physician orders, not nurse-initiated actions. Choice C relates to medical treatment, not nursing interventions. Choice D focuses on collaboration with other providers, not solely nurse-initiated actions. In summary, only choice B aligns with the independent and outcome-focused nature of nurse-initiated interventions.