Adult Health Nursing Study Guide Answers

Correct Answer: A

Rationale: The presentation described in the question is classic for anterior uveitis. Anterior uveitis is an inflammatory condition affecting the iris and ciliary body and is characterized by redness, pain, and photophobia. Slit-lamp examination typically reveals ciliary injection (redness around the iris), corneal edema, and a mid-dilated pupil with a fixed reaction to light due to inflammation causing spasm of the iris muscles. Acute angle-closure glaucoma would present with similar symptoms but would also have increased intraocular pressure, which is not mentioned in the presentation. Endophthalmitis is an infection of the intraocular cavities and would typically present with more severe symptoms, such as severe pain, vision loss, and presence of pus in the eye. Corneal abrasion would present with pain, foreign body sensation, and possibly tearing but would not cause ciliary injection or fixed pupil reaction as

Correct Answer: C

Rationale: The most effective intervention to prevent pressure ulcers in bedbound patients at risk, such as those with advanced dementia, is to use pressure-relieving support surfaces like specialized mattresses or cushions. These surfaces help distribute the pressure evenly, reducing the risk of pressure ulcer formation on bony prominences. Turning the patient every 2 hours (choice A) can also help relieve pressure, but it may not be sufficient to prevent pressure ulcers in high-risk individuals. Applying barrier creams or moisture barriers (choice B) can help protect the skin but may not address the underlying issue of pressure on vulnerable areas. Administering prophylactic antibiotics (choice D) is not recommended for preventing pressure ulcers as it does not address the root cause of the problem and can lead to antibiotic resistance. Therefore, the priority intervention should be to use pressure-relieving support surfaces to minimize the risk of pressure ulcers in

Correct Answer: A

Rationale: The symptoms described - sudden-onset severe headache, nausea, vomiting, photophobia, neck stiffness, and positive Kernig and Brudzinski signs - are classic manifestations of meningitis. Meningitis is an inflammation of the meninges, the protective membranes covering the brain and spinal cord, often caused by infection. The sudden onset of these symptoms and signs, along with neck stiffness and positive Kernig and Brudzinski signs (indicative of meningeal irritation), strongly suggest meningitis as the most likely diagnosis in this scenario.

Correct Answer: A

Rationale: The presentation described in the question is characteristic of anterior uveitis. Anterior uveitis is inflammation of the iris and ciliary body in the eye. Patients typically present with symptoms such as redness, pain, and photophobia. Slit-lamp examination findings include ciliary injection (redness and engorgement of blood vessels in the ciliary body), corneal edema (swelling of the cornea), and a mid-dilated pupil with a fixed reaction to light due to involvement of the iris muscles. These features differentiate anterior uveitis from other conditions. Treatment of anterior uveitis may involve topical steroids and cycloplegics to reduce inflammation and alleviate symptoms.

Correct Answer: A

Rationale: The nurse recommends regular monitoring of the patient's blood cholesterol levels to prevent complications from their heart disease. High levels of cholesterol can lead to the buildup of plaque in the arteries, increasing the risk of heart problems such as heart attacks and strokes. Monitoring cholesterol levels allows healthcare providers to assess the patient's risk and make appropriate recommendations for managing their heart disease. Regular monitoring can help track the effectiveness of lifestyle changes or medications in lowering cholesterol levels and reducing the risk of complications.