Adult Health Nursing Answer Key

Correct Answer: A

Rationale: The patient's sudden onset of severe vertigo, nausea, vomiting, and nystagmus following a recent upper respiratory tract infection is consistent with vestibular neuritis. Vestibular neuritis is characterized by acute onset vertigo, often severe, which is typically associated with nausea, vomiting, and nystagmus. The condition is thought to be caused by inflammation of the vestibular nerve, often viral in nature, which can occur following an upper respiratory tract infection. This inflammation leads to dysfunction of the vestibular system in the inner ear, resulting in the symptoms described. Benign paroxysmal positional vertigo (BPPV), characterized by brief episodes of vertigo triggered by specific head movements, is less likely in this case given the sudden onset of symptoms not triggered by head movements. Meniere's disease is characterized by recurrent episodes of vertigo accompanied by hearing loss, tinnitus, and a feeling of fullness

Correct Answer: B

Rationale: Atorvastatin is a medication commonly used for lipid-lowering therapy to reduce cholesterol levels and decrease the risk of cardiovascular events. However, one of the potential side effects of statin medications such as atorvastatin is liver injury. Therefore, monitoring liver function tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, is crucial during atorvastatin therapy.

Correct Answer: A

Rationale: Option A is the most appropriate nursing intervention to facilitate effective communication with the 80-year-old male patient. This approach involves waiting for the patient to be fully awake before discussing important information about the surgery and potential post-surgery events with both the patient and family. This allows the patient to fully comprehend the information provided and ask any necessary questions. Effective communication is crucial in promoting patient understanding and cooperation, especially in older adults who may require additional time to process information due to factors such as age-related cognitive changes. It is important to ensure that the patient receives clear and accurate information to support their recovery process and reduce anxiety.

Correct Answer: C

Rationale: Nurse Filomena would consider the purpose of the health fair to be multiphasic screening. A multiphasic screening event involves offering various health screening tests at the same time to individuals within the community. These screenings aim to detect a range of health conditions early on, ultimately promoting prevention and early intervention. By organizing a health fair with several screening tests being given simultaneously, Nurse Filomena's primary goal is likely to help identify health issues in the community proactively and provide education and resources for ongoing health promotion and disease prevention. While aspects of community service, community bonding, and case finding may also be outcomes of the health fair, the focus on conducting multiple screening tests aligns most closely with the concept of multiphasic screening as the primary purpose.

Correct Answer: B

Rationale: Pain is best described as a subjective unpleasant experience because it is unique to each individual and is influenced by a variety of factors including emotional, psychological, and cultural elements. Pain cannot be objectively measured or quantified, and therefore it is considered a subjective experience that is reported by the person experiencing it. This is why pain is often assessed using self-report scales and tools to capture the individual's perception of their pain intensity and quality.