Adult Health Nursing Study Guide Answers

Correct Answer: B

Rationale: The most appropriate intervention for a patient with difficulty swallowing due to end-stage ALS and concerns about choking is to refer the patient to a speech therapist for swallowing exercises and techniques (Choice B). Speech therapists are trained to assess and manage swallowing difficulties in patients, especially those with neurodegenerative diseases like ALS. They can provide specific exercises and strategies to help the patient swallow safely and reduce the risk of choking. This intervention focuses on addressing the underlying issue causing the difficulty swallowing and aims to improve the patient's quality of life by enhancing their ability to eat and drink. The other options are not as effective or appropriate in addressing the patient's concerns.

Correct Answer: A

Rationale: Total patient care model of nursing is focused on the task-oriented approach to client care. In this model, the nurse is responsible for all aspects of care for a group of patients during their shift. It involves providing direct care, coordinating with other healthcare team members, and overseeing the patients' overall well-being. This approach emphasizes a comprehensive and holistic view of the patient's needs, where the nurse is actively involved in all aspects of care delivery.

Correct Answer: C

Rationale: Sudden, severe chest pain and dyspnea in a postpartum client could be indicative of a potential serious condition, such as a pulmonary embolism or postpartum cardiomyopathy, which require immediate medical attention. Therefore, the most appropriate nursing action would be to notify the healthcare provider immediately for further evaluation and management. Placing the client in a semi-Fowler's position may provide some comfort but does not address the underlying cause of the symptoms. Administering supplemental oxygen therapy may be necessary once the healthcare provider assesses the client. Encouraging deep breathing exercises may not be appropriate if the client is experiencing severe chest pain and dyspnea, as it could worsen the situation.

Correct Answer: D

Rationale: In the scenario described, the patient is presenting with severe symptoms of acute exacerbation of asthma, including severe dyspnea, accessory muscle use, and inability to speak in full sentences. In such cases, the most appropriate intervention for assessing the severity of the asthma exacerbation and guiding management decisions is a clinical assessment using standardized severity scores.

Correct Answer: C

Rationale: Battery occurs when there is an intentional harmful or offensive contact with a person without their consent. In this scenario, Nurse Edna applied a body restraint to the patient without the doctor's order, which constitutes unauthorized physical contact. The patient did not give consent for the restraint, and Nurse Edna's action could be considered battery. It is important for healthcare providers to obtain proper authorization before using any form of physical restraint on a patient to avoid legal implications such as battery.