Adult Health Nursing Test Bank

Correct Answer: B

Rationale: When a woman in active labor exhibits signs of prolonged second stage, such as ineffective pushing efforts and slow fetal descent, one of the maternal conditions that should be considered is pelvic floor dysfunction. The pelvic floor muscles play a crucial role in supporting the uterus, bladder, and rectum. If these muscles are weak or dysfunctional, it can lead to difficulty in pushing effectively and impede the descent of the fetus through the birth canal. This can result in prolonged labor and increase the risk of complications for both the mother and the baby. Therefore, assessing for pelvic floor dysfunction is important in addressing the abnormal labor pattern and providing appropriate interventions to support the progress of labor.

Correct Answer: B

Rationale: The correct answer is B because disclosing a patient's HIV status to family members violates the patient's right to privacy and confidentiality. Patient confidentiality is a fundamental aspect of the Patient's Bill of Rights, ensuring that personal health information is protected. The other choices (A, C, D) do not directly violate the Patient's Bill of Rights. Choice A relates to transparency in billing, choice C is about honesty in communication, and choice D is about timely communication with the physician, all of which are in line with patient rights and quality care.

Correct Answer: C

Rationale: The correct answer is C because checking the completeness of the charting by doctors and nurses ensures that all necessary information is accurately documented, facilitating proper patient care and treatment. This step helps identify any missing or incorrect information that may impact patient safety. A: Storing the charts in respective shelves is a routine task that does not involve verifying the accuracy or completeness of the information. B: Separating medico-legal charts is important but does not directly address the completeness of charting by doctors and nurses. D: Binding the charts immediately is not necessary before ensuring the completeness and accuracy of the information documented.

Correct Answer: C

Rationale: The correct answer is C because positioning oneself at eye level helps the patient see the nurse's facial expressions and lip movements, aiding in communication. Speaking clearly and slowly allows the patient to better understand. Speaking loudly can distort sound and may not be necessary. Avoiding visual aids or gestures limits communication channels. Speaking quickly can overwhelm the patient and hinder comprehension.

Correct Answer: A

Rationale: The correct answer is A: Utilizing the nursing process in providing safe, quality nursing care. This is because the nursing process involves assessment, diagnosis, planning, implementation, and evaluation, which ensures comprehensive and individualized care. Documenting procedures (B) is important but does not guarantee meeting standards of care. Simply carrying out doctor's orders (C) may not address all aspects of patient care. Performing physical assessment (D) is crucial but only one component of the nursing process. Ultimately, utilizing the nursing process ensures holistic and evidence-based care, meeting the standards of care on falls.