Pharmacology and the Nursing Process 10th Edition Test Bank Quizlet

Correct Answer: B

Rationale: The correct answer is B: Safety of the immediate environment. This is crucial for the client's well-being and can impact their health. The nurse should assess for hazards like loose rugs, clutter, or slippery floors. This ensures a safe living environment for the client. The other choices (A, C, D) are not directly related to the client's immediate safety or well-being. The number of rooms in the house (A) is not as important as ensuring the safety of the environment. The frequency of home visits (C) can be planned later based on the initial assessment. The friendliness of the client and family (D) is important for building rapport but does not address the immediate safety concerns of the client.

Correct Answer: B

Rationale: Step-by-step rationale for choice B being correct: 1. Dehydration leads to electrolyte imbalances, which can exacerbate cardiac dysrhythmias. 2. Small frequent intake of fluids like juices, broth, or milk helps in gradual rehydration without overwhelming the cardiovascular system. 3. This approach allows for better absorption of fluids and nutrients, promoting hydration without causing sudden shifts in electrolyte levels. Summary of why other choices are incorrect: A: Just drinking a glass of water every hour may not address electrolyte imbalances or provide adequate hydration for a client with cardiac dysrhythmias. C: NG replacement may not be necessary if the client can tolerate oral intake, and it is more invasive than needed. D: A rapid IV infusion may lead to sudden changes in electrolyte levels, potentially worsening the dysrhythmias.

Correct Answer: D

Rationale: The correct answer is D: Vitamin D. Vitamin D is essential for the absorption of calcium in the intestines. Without sufficient vitamin D, the body cannot effectively absorb calcium, leading to potential issues with calcium absorption. Vitamin A (choice A) is not directly involved in calcium absorption. Vitamin B (choice B) and Vitamin C (choice C) also do not play a significant role in calcium absorption. Therefore, the lack of Vitamin D is the most likely cause for problems with calcium absorption.

Correct Answer: D

Rationale: The correct answer is D, "Ineffective thermoregulation related to dehydration." The client's high serum glucose level of 618mg/dl indicates severe hyperglycemia, leading to dehydration. The client's hot, dry skin and elevated temperature can be signs of dehydration, impacting the body's ability to regulate temperature. Dehydration can also affect other vital signs, contributing to the elevated heart rate and low blood pressure. Addressing ineffective thermoregulation is crucial as it can lead to further complications. Choices A, B, and C are not the highest priority because addressing dehydration and ineffective thermoregulation takes precedence due to the immediate risk of complications such as heatstroke or hypothermia. Deficient volume, decreased cardiac output, and imbalanced nutrition are important but not as urgent in this scenario.

Correct Answer: C

Rationale: The correct answer is C: An inference. When the nurse documents that the client is confused, it is an interpretation or conclusion drawn from the observed behavior or symptoms. Inferences are based on subjective and objective data. Subjective data (choice A) is based on what the client states, while a data cue (choice B) is a piece of information that may lead to an inference but is not the actual interpretation. Primary data (choice D) refers to firsthand information obtained directly from the client, which is not the case here. In this scenario, the nurse is making an inference based on the observed confusion, making choice C the correct answer.