Pharmacology and the Nursing Process 9th Edition Test Bank

Correct Answer: C

Rationale: The correct answer is C: Side lying position. This position helps prevent aspiration of secretions and promotes drainage from the mouth during and after a seizure. Placing the patient in a side lying position also helps prevent injury from falling and facilitates monitoring of the patient's airway. Incorrect choices: A: Low fowler's - This position does not provide optimal airway protection and may increase the risk of aspiration during a seizure. B: Modified trendelenburg - This position may worsen the patient's airway patency and does not facilitate drainage of secretions. D: Supine - Placing the patient in a supine position can lead to aspiration and compromise the airway, especially during a seizure. Summary: The side lying position is the most appropriate choice as it ensures airway protection, facilitates drainage, and reduces the risk of aspiration during and after a seizure.

Correct Answer: C

Rationale: The correct answer is C: IgM. During an acute infection, the body's initial response is rapid and non-specific, leading to the production of IgM antibodies first. IgM is the first immunoglobulin class produced in response to a new antigen, providing immediate protection. IgG is produced later in the immune response and is responsible for long-term immunity. IgE is involved in allergic reactions and parasitic infections, not typically the first response to infection. IgD is primarily found on the surface of B cells and its function is not well understood in the context of acute infections.

Correct Answer: A

Rationale: The correct answer is A: Fluid intake of less than 2,500mL. In diabetes insipidus, the body cannot properly regulate fluid balance, leading to excessive thirst and urination. Successful treatment aims to manage these symptoms by reducing fluid intake to prevent dehydration. Therefore, a decrease in fluid intake indicates successful treatment. Explanation for incorrect choices: B: Blood pressure of 90/50mmHg - Blood pressure is not directly related to the treatment of diabetes insipidus. C: Pulse rate of 126 beats/min - Pulse rate is not a specific indicator of successful treatment for diabetes insipidus. D: Urine output of more than 200mL/hour - In diabetes insipidus, excessive urine output is a symptom of the condition, so an increase in urine output does not indicate successful treatment.

Correct Answer: A

Rationale: Step 1: Assess the client's vital signs to confirm presence of fever. Step 2: Measure client's oral temperature to obtain accurate reading. Step 3: Document temperature and report findings to healthcare provider. Step 4: Initiate appropriate interventions based on temperature reading. Step 5: Reassess client's condition to evaluate effectiveness of interventions. Summary: Option A is correct as it directly addresses the cue of fever by confirming the temperature. Options B, C, and D are incorrect as they do not directly address the need to assess the client's temperature for accurate evaluation and intervention.

Correct Answer: B

Rationale: The correct answer is B because asking about the frequency of bowel movements is crucial in assessing diarrhea, a common symptom. This information helps determine the severity and duration of the condition, guiding the nurse in identifying potential causes and appropriate interventions. Choice A focuses on the cause of upset stomach, not specifically diarrhea. Choice C is more related to incontinence rather than diarrhea. Choice D is important but not directly related to establishing a nursing diagnosis for diarrhea. Therefore, Choice B is the most appropriate question to assist in accurately assessing and diagnosing diarrhea.