Adult Health Med Surg Nursing Test Banks

Correct Answer: D

Rationale: Tipping Claudia's head back slightly helps in reaching the conjunctival sac easily. The conjunctival sac is a small space between the lower eyelid and the eye itself where eye drops are typically administered. Tilting the head back allows for better access to this area, ensuring the eye drops are delivered accurately and effectively into the eye.

Correct Answer: A

Rationale: The clinical presentation of recurrent episodes of epistaxis, gum bleeding, and easy bruising, along with laboratory findings of prolonged bleeding time, normal platelet count, and normal coagulation studies (PT and aPTT) are highly suggestive of Von Willebrand disease. Von Willebrand disease is the most common inherited bleeding disorder and is characterized by a deficiency or dysfunction of von Willebrand factor (vWF), which plays a key role in platelet adhesion and aggregation. The prolonged bleeding time is due to impaired platelet adhesion to the damaged vessel wall in the absence of functional vWF. Normal platelet count and normal PT/aPTT help differentiate Von Willebrand disease from other bleeding disorders such as hemophilia and platelet function disorders like Glanzmann thrombasthenia and Bernard-Soulier syndrome.

Correct Answer: C

Rationale: Ms. Sanchez is violating the code of ethics for nurses. Nurses are expected to uphold professional behavior and maintain a positive public image. Endorsing a detergent product on TV Commercial wearing a mini skirt and a plunging neckline shirt may be seen as unprofessional and contrary to the image of a nursing professional. The code of ethics for nurses requires nurses to act with integrity, maintain professional boundaries, and avoid actions that could bring discredit to the profession. By engaging in this commercial, Ms. Sanchez is not upholding the ethical standards expected of nurses.

Correct Answer: B

Rationale: Bulimia nervosa is best defined as a pathological disorder involving recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, excessive exercise, or misuse of laxatives. It is categorized as an eating disorder rather than a phobic disorder as it involves behaviors related to food consumption and body image, not just fears or phobias. Bulimia is not solely associated with starving oneself, as individuals with bulimia tend to consume large amounts of food during binge episodes. Therefore, the most accurate definition of bulimia is a pathological disorder of binging and vomiting.

Correct Answer: B

Rationale: A temperature of 39.8 degrees Celsius (103.6 degrees Fahrenheit) in a patient following abdominal surgery and ongoing blood transfusion may indicate an ongoing potential infection. During surgery, the body is exposed to various microorganisms, and the stress of surgery can weaken the immune system, making the patient more susceptible to infections. Blood transfusions also carry a risk of introducing infections if not properly screened. Therefore, in this situation, an elevated temperature may be a sign that an infection is developing, and prompt notification of the surgeon is important for further evaluation and management.