Adult Health Nursing Study Guide Answers

Correct Answer: C

Rationale: An amniotic fluid embolism is a rare and life-threatening complication during labor and delivery. It occurs when amniotic fluid or fetal cells enter the maternal circulation, triggering a rapid immune response that can lead to cardiovascular collapse and respiratory failure. The priority nursing intervention for a woman in active labor diagnosed with an amniotic fluid embolism is to initiate cardiopulmonary resuscitation (CPR) to support her vital functions and circulation. Providing immediate CPR can help sustain her until further medical interventions can be implemented. Administering oxygen and preparing for a cesarean section may be necessary but should occur after CPR is initiated to stabilize the woman's condition. Inserting an indwelling urinary catheter is not the priority in this emergency situation, as maintaining adequate cardiac and respiratory function takes precedence.

Correct Answer: A

Rationale: Prior to a gastric lavage procedure, it is essential for the nurse to ensure the correct size of the nasogastric tube is selected. The appropriate size of the tube will allow for effective removal of the ingested poisonous substance during the procedure. Proper sizing also helps in preventing complications such as injury to the gastrointestinal tract or inadequate removal of the substance. This step is crucial for the safe and successful completion of gastric lavage. Reminding parents to be careful, obtaining informed consent immediately, or accusing them of negligence are not immediate responsibilities of the nurse in this context.

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: D

Rationale: A directional hypothesis predicts the direction of the relationship between variables. In this case, the statement "A significant relationship exists between the caring behaviors of the staff-nurses and degree of satisfaction of ostomized patients" clearly indicates the direction of the expected relationship. This hypothesis suggests that there will be a positive or negative relationship between the caring behaviors of staff nurses and the satisfaction of ostomized patients. The terms "significant relationship" and "degree of satisfaction" indicate that the hypothesis is specific and measurable, making it suitable for testing through research methods.

Correct Answer: B

Rationale: In a pregnant woman presenting with severe abdominal pain and vaginal bleeding at 8 weeks gestation with a closed cervix, the most likely cause of these symptoms is a threatened abortion. A threatened abortion is a common complication of early pregnancy characterized by vaginal bleeding and lower abdominal pain without cervical dilation. The cervix remains closed, indicating that the pregnancy is still intact but at risk of potential miscarriage. Placenta previa typically presents with painless vaginal bleeding in the second or third trimester, whereas ectopic pregnancy usually presents with abdominal pain and vaginal bleeding in the setting of a closed cervix but is less likely at 8 weeks gestation. Gestational trophoblastic disease is a rare cause of vaginal bleeding in pregnancy and typically presents in the first trimester with signs of hyperemesis gravidarum, uterine enlargement, and elevated β-hCG levels.