Adult Health Med Surg Nursing Test Banks

Correct Answer: C

Rationale: A living will is a legal document that outlines a person's preferences and wishes regarding medical treatment, including resuscitation, in the event they become unable to communicate or make decisions. In this scenario, the client being admitted to the oncology unit wants to convey his wishes regarding resuscitation in case of cardiopulmonary arrest. A living will helps ensure that these wishes are known and respected by healthcare providers and loved ones. While a will addresses how a person's assets should be distributed after death and a health care power of attorney designates someone to make medical decisions on the person's behalf, a living will specifically focuses on healthcare preferences and treatment decisions. A proxy directive is similar to a health care power of attorney, designating someone to make healthcare decisions for the person if they are unable to do so themselves.

Correct Answer: C

Rationale: Using professional medical interpreters is the best approach when communicating with a patient who speaks a different language. This ensures accurate communication and helps prevent misunderstandings that can have serious consequences for the patient's health. Family members or friends may not be fluent in the necessary medical terminology and could unintentionally misinterpret information. Relying solely on written instructions can also be risky as the patient may have difficulty reading or comprehending the information. Speaking loudly and slowly may come across as disrespectful and does not address the root issue of the language barrier. Professional medical interpreters are trained to facilitate effective communication between healthcare providers and patients, ensuring that the patient receives the best possible care.

Correct Answer: B

Rationale: Uterine hyperstimulation is a condition in which the uterus contracts too frequently or too intensely, leading to decreased blood flow and oxygenation to the placenta. This can result in maternal fatigue and decreased fetal oxygenation due to the lack of sufficient rest intervals between contractions. Uterine hyperstimulation can be caused by factors such as the use of synthetic oxytocin (Pitocin) to induce or augment labor, uterine abnormalities, or maternal conditions like pre-eclampsia. It is important for the nurse to assess for uterine hyperstimulation in a woman experiencing frequent and intense contractions to intervene promptly and prevent adverse outcomes for both the mother and the baby.

Correct Answer: D

Rationale: Postpartum hemorrhage (PPH) is a significant complication after childbirth. The risk factors for PPH that are typically included in the list are uterine atony, overdistended uterus (e.g., multiple gestation or polyhydramnios), and ruptured uterus. Retroversion of the uterus is not a known risk factor for PPH. Retroversion refers to the position of the uterus, where it is tilted back towards the rectum. While retroverted uterus can sometimes lead to other issues or complications during pregnancy, it is not directly associated with an increased risk of postpartum hemorrhage.

Correct Answer: A

Rationale: A patient with a severe viral infection exhibiting reduced levels of circulating lymphocytes is likely due to the apoptosis of infected lymphocytes. When a virus enters the body, it can infect and replicate within lymphocytes, subsequently triggering the immune system to induce apoptosis in infected cells to prevent further spread of the virus. This process is part of the body's defense mechanism to control the viral infection. As a result, the circulating lymphocyte levels may decrease as infected lymphocytes are targeted for apoptosis. This phenomenon helps to limit viral replication and spread within the body, thereby aiding in the immune response to eliminate the virus.