Adult Health Nursing Test Bank

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Confirming the patient's identity ensures the right patient is receiving the intended procedure. 2. Verifying the procedure site using two identifiers prevents errors in site selection. 3. This step aligns with the World Health Organization's Surgical Safety Checklist, reducing the risk of wrong-site procedures. 4. Positioning, sedation, and local anesthesia are important but secondary to ensuring the correct patient and site. Summary: - Option B: Positioning is essential but not the top priority for procedural accuracy. - Option C: Sedation aims to minimize discomfort but does not guarantee procedural accuracy. - Option D: Administering local anesthesia is crucial but not as critical as confirming patient identity and procedure site.

Correct Answer: C

Rationale: The correct answer is C: Anaphylaxis. Anaphylaxis is the MOST severe form of an allergic reaction, including latex allergy. It is a systemic, potentially life-threatening reaction that can involve multiple organ systems. Symptoms can include difficulty breathing, swelling of the throat, a rapid drop in blood pressure, and cardiovascular collapse. Pruritus, erythema, and swelling (choice A) are common symptoms of allergic reactions but not specific to anaphylaxis. Asthma (choice B) can be a manifestation of latex allergy but is not the most severe form. Blisters and other skin lesions (choice D) are not typical of anaphylaxis but can occur in some cases of contact dermatitis from latex exposure.

Correct Answer: B

Rationale: The correct answer is B because the death of a spouse, child, or death by suicide are all significant losses that can lead to complicated grief due to the intensity of emotions and the disruption of daily life. These experiences can result in prolonged and severe grieving processes that may require professional intervention. Explanation for other choices: A: Childbirth, marriage, and divorce are not typically considered risk factors for complicated grief as they are more commonly associated with expected life events that may involve grief but not necessarily lead to complicated grief. C: Inadequate perception of the grieving process may contribute to difficulties in coping with grief but is not a direct risk factor for complicated grief. D: While inadequate support can impact the grieving process, and old age may present unique challenges, they are not specific risk factors for complicated grief compared to the profound loss experienced in choice B.

Correct Answer: A

Rationale: Precipitous labor is characterized by rapid cervical dilation and descent of the fetal presenting part, leading to a shortened labor duration of less than 3 hours. This rapid progression can increase the risk of maternal complications, such as postpartum hemorrhage. Postpartum hemorrhage is defined as excessive bleeding of more than 500 ml after vaginal delivery or more than 1000 ml after cesarean delivery. The rapid delivery in precipitous labor can result in inadequate uterine contractions after delivery, leading to poor uterine tone and potential postpartum hemorrhage due to uterine atony. Therefore, the nurse should anticipate postpartum hemorrhage as a potential maternal complication in a woman experiencing precipitous labor.

Correct Answer: A

Rationale: The correct answer is A: Identify and count cases. In the initial stages of an outbreak investigation, it is crucial to identify and count cases to understand the scope and magnitude of the outbreak. By counting cases, Nurse Rona and her team can track the spread of the disease, identify common characteristics among those affected, and determine the extent of the outbreak. This step helps in guiding further investigation and control measures. Summary of other choices: B: Define and identify cases - While defining cases is important, it is not the initial step in outbreak investigation. C: Verify diagnosis - Verifying diagnosis is important but comes after identifying and counting cases. D: Prepare for field work - Field work is important in outbreak investigations, but it typically comes after the initial step of identifying and counting cases.