Foundations and Adult Health Nursing Study Guide Answers

Correct Answer: B

Rationale: The presentation of a painful, vesicular rash in a dermatomal distribution on the left thorax, specifically in a patient with a history of chickenpox, is most suggestive of herpes zoster, commonly known as shingles. Herpes zoster is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve cells and can reactivate years later to cause shingles. The rash in herpes zoster typically progresses through different stages, including red patches leading to fluid-filled blisters. The characteristic rash typically appears unilaterally and is usually preceded by pain, burning, or tingling in the affected area. Unlike herpes simplex virus infection, which can cause similar lesions but is not typically localized to a specific dermatome, herpes zoster presents as a distinct unilateral cluster of vesicles along

Correct Answer: A

Rationale: Nursing intervention should prioritize providing education on proper incisional wound care techniques to promote optimal healing of the abdominal incision. This may include instructions on how to clean the incision site, signs and symptoms of infection, and when to seek medical attention. Proper wound care can help prevent complications such as infection and dehiscence, leading to better outcomes for the client. Administering prophylactic antibiotics, encouraging the use of abdominal binders, and instructing the client on activity restrictions are also important interventions, but educating the client on wound care techniques is crucial for their active participation in their recovery process.

Correct Answer: B

Rationale: Antipsychotic medications can cause metabolic side effects, including hyperglycemia (high blood sugar). Patients with bipolar disorder who are prescribed antipsychotic medications are at risk for developing new-onset diabetes or exacerbating preexisting diabetes. Monitoring blood glucose levels is essential to detect hyperglycemia early and prevent complications such as diabetic ketoacidosis. While hypertension, hypotension, and hypernatremia are possible side effects of certain medications, they are not typically associated with antipsychotic medications commonly used in the management of bipolar disorder. Hyperglycemia is a serious concern in this population due to the risk of developing diabetes or worsening of existing diabetes.

Correct Answer: A

Rationale: The patient's presentation of a pruritic, annular rash with fine scaling and central clearing, affecting the trunk and proximal extremities, following exposure to a new soap and laundry detergent is most consistent with tinea corporis, commonly known as ringworm. Ringworm is a superficial fungal infection caused by dermatophytes that can present with circular or annular lesions with central clearing and scaling. The exposure to new soap and laundry detergent may have disrupted the skin's microbiome, making it more vulnerable to fungal infections like tinea corporis. Nummular eczema typically presents as coin-shaped plaques rather than annular lesions, while pityriasis rosea presents with a herald patch followed by smaller similar lesions in a "Christmas tree" distribution. Lichen planus would not typically be associated with exposure to new soap and laundry detergent but can have distinct purple, polygonal papules.

Correct Answer: B

Rationale: Streptococcus pneumoniae is the most common causative organism of bacterial pneumonia in adults. It is responsible for the majority of community-acquired pneumonia cases. Streptococcus pneumoniae is a gram-positive bacteria and is known to cause typical pneumonia characterized by sudden onset of high fever, productive cough with blood-tinged or rust-colored sputum, chest pain, and consolidation on chest imaging. Other organisms like Legionella pneumophila (choice A), Mycoplasma pneumoniae (choice C), and Haemophilus influenzae (choice D) can also cause pneumonia, but Streptococcus pneumoniae is the most likely culprit based on the patient's test results.