Adult Health Nursing Test Bank

Correct Answer: B

Rationale: The correct answer is B: Initiate non-invasive positive pressure ventilation (NIPPV) for respiratory support. In acute exacerbations of COPD, NIPPV helps improve ventilation and oxygenation, reducing the work of breathing and preventing the need for intubation. This intervention is a priority as it can rapidly stabilize the patient's respiratory status. A: Administering bronchodilator medications is important in COPD management, but in severe exacerbations, NIPPV takes precedence. C: Arterial blood gas analysis is important for assessing oxygenation and ventilation status, but it does not directly address the acute respiratory distress. D: Chest physiotherapy can help with airway clearance in COPD, but in acute exacerbations, respiratory support with NIPPV is more urgent.

Correct Answer: C

Rationale: The correct answer is C because positioning oneself at eye level helps the patient see the nurse's facial expressions and lip movements, aiding in communication. Speaking clearly and slowly allows the patient to better understand. Speaking loudly can distort sound and may not be necessary. Avoiding visual aids or gestures limits communication channels. Speaking quickly can overwhelm the patient and hinder comprehension.

Correct Answer: B

Rationale: The correct answer is B: Herpes simplex virus infection. The presentation of a painful, vesicular rash following a linear pattern on the left forearm is characteristic of herpes simplex virus infection, specifically herpes zoster (shingles). The linear pattern is due to the virus following a specific nerve pathway. This is different from the other choices - A: Allergic contact dermatitis typically presents as a diffuse rash at the site of contact with an allergen, not a linear pattern. C: Scabies presents with burrows and papules, not vesicles in a linear pattern. D: Poison ivy dermatitis causes a diffuse rash, not a linear vesicular rash.

Correct Answer: B

Rationale: The primary goal of CPR is to restore spontaneous circulation and oxygenation to the body to maintain vital organ function. By performing chest compressions and rescue breaths, CPR aims to circulate oxygenated blood to the brain and other vital organs. This is crucial to prevent brain damage and increase the chances of survival. The other choices are incorrect because CPR does not address the underlying cause of cardiac arrest (A), provide pain relief (C), or prevent further complications such as organ failure (D). The immediate focus in a cardiac arrest situation is to maintain blood flow and oxygen delivery to vital organs until advanced medical care can be provided.

Correct Answer: C

Rationale: The correct answer is C: Umbilicus. The nurse begins assessing the uterine fundus at the level of the umbilicus as it is a standard reference point for postpartum fundal height measurement. This location allows for consistency and accuracy in tracking the descent of the uterus back into the pelvic cavity. Starting at the umbilicus also helps in monitoring the involution process and prevents potential errors in fundal height assessment. Symphysis pubis (A) is too low and not typically used as a reference point for uterine fundal assessment. Midline (B) is vague and does not provide a specific anatomical landmark. Sides of the abdomen (D) do not give a standardized starting point for measuring the uterine fundus, leading to potential variability in assessment.