Foundations and Adult Health Nursing Test Bank

Correct Answer: B

Rationale: During the acute phase response, C-reactive protein (CRP) primarily serves to activate the complement system. CRP binds to phosphocholine on the surface of pathogens, allowing for the activation of the classical pathway of the complement system. This leads to the recruitment of immune cells, opsonization of pathogens, and enhancement of phagocytosis. The activation of the complement system by CRP plays a crucial role in the host defense against infections, aiding in the elimination of pathogens and the resolution of inflammation.

Correct Answer: D

Rationale: Ensuring the availability of emergency equipment and resuscitation medications is crucial to prioritize patient safety during a transesophageal echocardiogram (TEE) procedure. TEE involves inserting a specialized probe (transducer) into the esophagus to obtain detailed images of the heart. While complications during TEE are rare, they can include adverse reactions to sedation, esophageal injury, arrhythmias, or other cardiac events. By having emergency equipment and resuscitation medications readily available, the healthcare team can respond promptly to any unforeseen complications or emergencies that may arise during the procedure, ensuring optimal patient safety. Placing the patient in a supine position, providing sedation, and advising the patient to fast before the procedure are important aspects of the TEE process; however, ensuring emergency preparedness takes precedence in prioritizing patient safety during the procedure.

Correct Answer: B

Rationale: Medical records are typically required to be retained for a certain period of time as mandated by legal and regulatory requirements. The retention period for medical records is generally between 5 to 10 years, depending on the jurisdiction and specific regulations governing healthcare facilities. Keeping medical records for this duration ensures that they are available for reference, audits, legal purposes, and continuity of care for patients. Storing medical records for an adequate length of time also helps in ensuring continuity of care and tracking patients' medical history over time, which is crucial for quality healthcare delivery. Therefore, storing charts in the Medical Records or storage room for at least 5-10 years aligns with standard practices in healthcare compliance and patient care.

Correct Answer: A

Rationale: Endometriosis is a condition characterized by the abnormal growth of endometrial tissue outside the uterus. One common symptom of endometriosis is excessive menstrual bleeding, known as menorrhagia. This excessive bleeding is due to the presence of endometrial tissue in abnormal locations, leading to inflammation, scarring, and blood accumulation. In severe cases, endometriosis can lead to the formation of adhesions, cysts, and scar tissue, causing significant pain and fertility issues for affected individuals. Endometrial hyperplasia, leiomyomas (uterine fibroids), and adenomyosis are other gynecological conditions, but they do not involve the abnormal proliferation of endometrial tissue outside the uterus like endometriosis does.

Correct Answer: B

Rationale: The nurse's best approach to address the patient's fear of pain is to provide accurate information about pain management strategies and options. In doing so, the nurse can help alleviate the patient's concerns by empowering them with knowledge and potential solutions for managing pain during and after the procedure. By acknowledging the patient's fear and addressing it with practical information, the nurse can build trust, reduce anxiety, and create a more supportive and collaborative environment for the patient. Dismissing, ignoring, or invalidating the patient's fear would not be effective in addressing the underlying concerns and could potentially lead to increased distress and resistance to the recommended procedure.