Adult Health Nursing Test Bank

Correct Answer: A

Rationale: The correct answer is A: Implement environmental modifications to promote sleep hygiene. Delirium is often triggered by environmental factors like noise, light, and disruption of sleep. By optimizing the environment for rest and minimizing stimuli, the patient's delirium can improve. This approach focuses on addressing the root cause rather than just managing symptoms. Choice B is incorrect because antipsychotic medications can worsen delirium and are not recommended as first-line treatment. Choice C is not the priority as ruling out focal deficits may be important but does not directly address the delirium. Choice D is incorrect as benzodiazepines can exacerbate delirium and are not recommended due to their potential to worsen cognitive function.

Correct Answer: A

Rationale: The correct answer is A: Scabies. This presentation is classic for scabies infestation caused by the Sarcoptes scabiei mite. The intensely pruritic linear burrows are pathognomonic. Close contact with an individual with scabies increases the likelihood of transmission. The other choices, B: Pediculosis, C: Tinea corporis, and D: Contact dermatitis, do not typically present with linear burrows on the hands and wrists. Pediculosis presents with lice infestation, Tinea corporis with circular lesions, and contact dermatitis with erythema and edema.

Correct Answer: C

Rationale: The correct answer is C: cope with anxiety. The nurse's goal is to address Belle's difficulty tolerating frustration, which likely leads to anxiety. By helping Belle develop coping strategies for managing her anxiety, the nurse can assist her in handling frustration more effectively. Options A, B, and D are incorrect because increasing self-esteem, recognizing needs, and mobilizing resources may be important aspects of Belle's overall care but are not directly related to addressing her difficulty with frustration and anxiety. Focusing on coping with anxiety directly targets the root issue and is the most appropriate goal in this context.

Correct Answer: C

Rationale: The correct answer is C: Durable power of attorney. This legal document allows Mr. M to appoint his daughter as his healthcare proxy, granting her the authority to make medical decisions on his behalf if he becomes incapacitated. A: Expressed contract involves clear terms agreed upon by both parties, not relevant here. B: Implied contract arises from actions rather than explicit agreement, not applicable in this situation. D: A living will outlines an individual's medical treatment preferences, but does not grant decision-making authority to another person.

Correct Answer: B

Rationale: The correct answer is B: Report any irregular vaginal bleeding. This is important because irregular vaginal bleeding can indicate potential issues such as breakthrough bleeding or hormonal imbalances, which may require adjustments to the contraceptive regimen. Other choices are incorrect because: A) Restricting sexual activity is not necessary with this medication, C) Increasing calcium intake is not directly related to taking biphasic anti-ovulatory medication, and D) Bi-monthly Pap smears are not specifically required due to this type of contraception.