Professional Nursing Concepts and Challenges Test Bank

Questions 14

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Professional Nursing Concepts and Challenges Test Bank Questions

Question 1 of 5

A nurse is assessing a client during labor and delivery. Which condition should the nurse recognize as a risk factor for disseminated intravascular coagulation (DIC)?

Correct Answer: C

Rationale: Placental abruption is the separation of the placenta from the uterine wall before delivery. This condition is a significant risk factor for disseminated intravascular coagulation (DIC) because the sudden detachment can lead to massive internal bleeding. The release of large amounts of tissue factor from the placenta into the maternal circulation triggers widespread activation of the coagulation cascade, leading to the consumption of clotting factors and platelets. This uncontrolled activation of the clotting system can result in both excessive clot formation and bleeding, characteristic of DIC. Gestational diabetes, polyhydramnios, and placenta previa are not direct risk factors for DIC.

Question 2 of 5

The nurse instructs a client about the medication nifedipine (Procardia) for hypertension. Which client statement indicates that additional teaching is needed?

Correct Answer: A

Rationale: Swelling of the ankles (edema) is a common side effect of nifedipine (Procardia), especially when starting the medication. However, it is important for the client to understand that while edema is a known side effect, it is not considered normal and should be monitored. The client should report any significant or concerning swelling to their healthcare provider. Options B, C, and D demonstrate good understanding of the medication and its management.

Question 3 of 5

The nurse is instructing the spouse of a client with a stroke on how to do passive range-of- motion exercises to the affected limbs. Which rationale for this intervention will the nurse include in the teaching session?

Correct Answer: D

Rationale: Passive range-of-motion exercises are beneficial in maintaining joint flexibility in clients with stroke. These exercises involve moving the client's limbs through a full range of motion, which helps prevent joint contractures and stiffness. Joint flexibility is crucial for maintaining mobility and preventing secondary complications such as pressure ulcers. While passive range-of-motion exercises may indirectly impact muscle strength, cardiorespiratory function, and endurance, the primary rationale for this intervention is to maintain joint flexibility.

Question 4 of 5

The nurse is planning care for a group of clients. Which client should the nurse identify as having the greatest risk for developing deep venous thrombosis (DVT)?

Correct Answer: D

Rationale: The client recovering from knee replacement surgery has the greatest risk for developing deep venous thrombosis (DVT). Knee replacement surgery is a major orthopedic procedure that involves prolonged immobility and disruption of the normal blood flow in the lower extremities, which increases the risk of developing DVT. Postoperative patients are at a higher risk for developing blood clots due to reduced mobility, surgical trauma, and alterations in blood flow. Therefore, it is essential for healthcare providers to implement preventive measures to reduce the risk of DVT, such as early mobilization, compression stockings, and pharmacological prophylaxis.

Question 5 of 5

The nurse identifies that a patient with immobility is at risk for the development of urolithiasis. What should the nurse include when planning this patient�s care?

Correct Answer: D

Rationale: Immobility can contribute to the development of urolithiasis (the formation of urinary calculi or stones) due to decreased mobility leading to stagnant urine flow, which can result in the concentration of crystal-forming substances in the urine. Increasing fluid intake helps prevent urinary stasis and dilutes the urine, reducing the risk of stone formation. Adequate hydration can also help flush out any existing crystals or small stones before they grow larger. Therefore, increasing fluid intake to 3000 mL/day is essential in preventing urolithiasis in patients with immobility. Monitoring urine pH, administering calcium supplements, or maintaining an indwelling urinary catheter are not appropriate interventions for preventing urolithiasis in this situation.

Similar Questions

The nurse identifies that a patient with immobility is at risk for the development of urolithiasis. What should the nurse include when planning this patient�s care?
A nurse is assessing a client during labor and delivery. Which condition should the nurse recognize as a risk factor for disseminated intravascular coagulation (DIC)?
A patient with inflammatory bowel disease is prescribed sulfasalazine (Azulfidine). What should the nurse teach the patient about taking this medication?
A client admitted with the diagnosis of cardiomyopathy becomes short of breath with ambulation and eating and fatigued with routine care activities. Which nursing diagnosis does the nurse include in the client's plan of care?
Which is believed to be the cause of preeclampsia?

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