foundation of nursing questions

Correct Answer: B

Rationale: The correct answer is B: The patient is likely to experience resolution of conductive hearing loss after the procedure. This information is crucial to include in the preoperative teaching because it directly addresses the patient's expected outcome, providing reassurance and setting appropriate expectations. Stapedectomy with prosthesis insertion is a well-established treatment for otosclerosis-related conductive hearing loss. Choices A, C, and D are incorrect because they either provide misleading information (A, D) or are not directly relevant to the procedure or the patient's immediate postoperative experience (C). It is important to focus on accurate and relevant information to prepare the patient effectively for the upcoming surgery and its expected outcomes.

Correct Answer: D

Rationale: The correct answer is D: Risk for Impaired Gas Exchange Related to Airway Obstruction. This should be prioritized because hereditary angioedema can lead to swelling in the airway, potentially causing respiratory distress and compromising gas exchange. This nursing diagnosis addresses the immediate threat to the patient's respiratory function. A: Risk for Infection Related to Skin Sloughing - While skin sloughing can occur with hereditary angioedema, it is not the priority over ensuring adequate gas exchange. B: Risk for Acute Pain Related to Loss of Skin Integrity - Pain management is important, but addressing airway obstruction takes precedence due to the potential for respiratory compromise. C: Risk for Impaired Skin Integrity Related to Cutaneous Lesions - Skin integrity issues may be present but do not pose as immediate a threat as airway obstruction.

Correct Answer: C

Rationale: The correct answer is C because an older patient with glaucoma is at risk for increased intraocular pressure when receiving an enema. This situation requires immediate attention to prevent potential complications like vision loss. The other choices do not pose immediate risks that require urgent intervention. A and B can wait for a brief period, while D is not time-sensitive in the context of a myocardial infarction. The priority is always given to the patient with the highest risk of harm if the intervention is delayed.

Correct Answer: D

Rationale: The correct answer is D because a dyspneic patient with a tracheostomy may have difficulty speaking due to impaired airflow and mobility of the tongue. In this case, using alternative communication methods such as writing or using communication boards would be more effective. Choice A is incorrect because being blind does not directly impact communication in this scenario. Choice B is incorrect as hunger, alertness, and self-esteem do not relate to the communication challenges presented. Choice C is incorrect as depression, while important to consider, is not the primary factor impacting communication in this case.

Correct Answer: B

Rationale: The correct answer is B: Flex head with chin tuck. This position helps prevent aspiration by closing off the airway during swallowing. Flexing the head and tucking the chin promotes safe swallowing and reduces the risk of choking. Placing food on the left side (choice C) is not relevant to addressing the patient's symptoms. Positioning in semi-Fowler's (choice A) may not directly address the swallowing difficulty. Offering fruit juice (choice D) does not address the patient's specific feeding needs and may not be safe if the patient has swallowing difficulties.