Adult Health Nursing Study Guide Answers

Correct Answer: D

Rationale: The clinical presentation of chest pain, dyspnea, and a friction rub heard on auscultation is suggestive of pericarditis. The diffuse ST-segment elevation seen on the electrocardiogram (ECG) is a classic finding in pericarditis, known as the "universal sign." In contrast, stable angina typically presents with chest pain on exertion that is relieved by rest or nitroglycerin, while unstable angina presents with chest pain at rest or with minimal exertion. Acute myocardial infarction would typically present with ST-segment elevation in specific leads correlating with the area of myocardial ischemia/infarction. However, in the context of diffuse ST-segment elevation and symptoms suggestive of inflammation (friction rub), the most likely diagnosis is pericarditis.

Correct Answer: C

Rationale: While proton pump inhibitors (PPIs) are commonly prescribed for the treatment of peptic ulcer disease to help heal ulcers and reduce acid production, it is important for the nurse to educate the patient about potential risks associated with PPI therapy. PPIs have been associated with an increased risk of gastrointestinal bleeding, especially in patients with a history of peptic ulcer disease. It is crucial for the patient to be aware of this risk and to take precautions, such as avoiding other medications that can increase bleeding risk and informing healthcare providers about any signs of bleeding, such as black stools or abdominal pain. Educating the patient about this potential adverse effect allows for early recognition and prompt intervention if necessary.

Correct Answer: A

Rationale: Having a tracheostomy means that a patient has an artificial opening in their neck to help them breathe. Therefore, any issues related to breathing, such as blockages in the tracheostomy tube or difficulty in clearing secretions, can pose a major problem for a patient with a tracheostomy. It is crucial to monitor the patient's respiratory status closely and intervene promptly if any breathing difficulties arise to prevent potential respiratory distress or complications.

Correct Answer: A

Rationale: The clinical presentation of urinary urgency, frequency, and nocturia along with prostate enlargement with a smooth, firm consistency on digital rectal examination (DRE) is classic for benign prostatic hyperplasia (BPH). BPH is a common condition in aging men characterized by non-malignant growth of the prostate gland, which can cause varying degrees of lower urinary tract symptoms due to obstruction of the urethra. In contrast, prostate cancer typically presents with findings like an asymmetric, hard, or nodular prostate on DRE, while prostatitis presents with symptoms like fever, perineal pain, and systemic symptoms. Urinary tract infection (UTI) may present with dysuria, frequency, urgency, and suprapubic pain, but it does not usually cause prostate enlargement.

Correct Answer: B

Rationale: The best approach for the nurse in this situation is to listen actively to the patient's religious beliefs, respect their autonomy, and explore alternative treatment options. It is important for the nurse to understand and acknowledge the patient's perspective, even if it conflicts with the recommended treatment plan. By showing respect for the patient's beliefs and involving them in the decision-making process, the nurse can work collaboratively with the patient to find a solution that aligns with their religious beliefs while also addressing their medical needs. This approach promotes patient-centered care and helps build a trusting and therapeutic relationship between the nurse and the patient.