Adult Health Med Surg Nursing Test Banks

Correct Answer: A

Rationale: When a baby is placed on phototherapy, especially for treating jaundice, it is crucial for the nurses to put sunglasses on the newborn to protect their eyes. Phototherapy involves exposing the baby's skin to certain types of light to help break down the bilirubin causing the jaundice. However, this light can be harmful to the baby's sensitive eyes, potentially leading to eye damage or other eye-related issues if not protected adequately. Therefore, placing sunglasses on the newborn is a necessary precaution to ensure the safety and well-being of the baby's eyes during the treatment.

Correct Answer: A

Rationale: Grounded theory is a qualitative research method that focuses on generating theory from data rather than testing pre-existing theories. In this scenario, where the goal is to explore social processes observed in the delivery room activities, grounded theory would be the most appropriate method. This method allows researchers to systematically collect and analyze data in order to develop theoretical explanations for social phenomena. By using grounded theory, researchers can explore the interactions, behaviors, and social processes at play in the delivery room in a structured and systematic way, thereby gaining insights into these phenomena through an inductive approach.

Correct Answer: C

Rationale: The symptoms described in the scenario - chest pain, dyspnea, and cyanosis - are indicative of a potential air embolism. Air embolism occurs when air enters the bloodstream, leading to blockages in blood vessels and impeding oxygen delivery to tissues. In patients receiving Total Parenteral Nutrition (TPN) through intravenous lines, the risk of air embolism exists during line manipulations, disconnections, or improper priming of the tubing. The sudden onset of symptoms like chest pain and cyanosis in a patient on TPN should raise suspicion for an air embolism, as it requires immediate intervention to prevent further complications such as cardiac arrest or stroke.

Correct Answer: B

Rationale: The pharynx is the structure responsible for transporting food from the oral cavity to the esophagus during swallowing. When food is chewed and mixed with saliva in the oral cavity, it forms a bolus that is propelled to the pharynx by the tongue. The pharynx serves as a common passageway for both air and food, allowing the bolus to pass into the esophagus while preventing it from entering the trachea. The epiglottis, although important in preventing food from entering the airway, is not directly involved in the transportation of food from the oral cavity to the esophagus.

Correct Answer: B

Rationale: When a patient receiving palliative care for end-stage COPD expresses a desire to discuss advance care planning, the palliative nurse should initiate a conversation about advance directives and future care preferences. Advance care planning involves discussing and documenting a patient's preferences regarding future medical care, particularly in situations where the patient may no longer be able to make decisions. This discussion helps ensure that the patient's wishes are respected and followed in the event they are unable to communicate their preferences. By engaging in advance care planning discussions, the nurse can help the patient feel empowered, supported, and in control of their medical care decisions. It also allows healthcare providers to align care with the patient's values and goals, ultimately improving quality of life and ensuring dignity at the end of life.