Foundations and Adult Health Nursing Test Bank

Correct Answer: A

Rationale: The nurse in the practice of her profession is guided by a code of ethics, which outlines the moral duties and professional responsibilities of nurses. The code of ethics provides a framework for ethical decision-making and sets standards for professional behavior within the nursing profession. Nurses are expected to adhere to the principles of the code of ethics in order to promote the well-being and safety of their patients, maintain professional integrity, and uphold the values of nursing practice.

Correct Answer: C

Rationale: Postpartum hemorrhage is a serious complication that can occur within the first 24 hours after childbirth. It is the leading cause of maternal mortality worldwide. Therefore, during the immediate postpartum period, the first priority nursing intervention should be focused on observing for signs and symptoms of postpartum hemorrhage, such as excessive bleeding, abnormal vital signs, and changes in uterine tone. Early detection and prompt intervention can prevent severe complications and save the mother's life. Monitoring urinary output, taking vital signs, and checking level of responsiveness are important aspects of postpartum care but observing for postpartum hemorrhage takes precedence due to its critical nature.

Correct Answer: B

Rationale: Accurate assessment and intervention by the nurse or helping person are critical factors for successful integration of loss during the grieving process. This involves the nurse's ability to assess the patient's grieving process effectively, identify their needs, provide appropriate support, and intervene when necessary. By utilizing proper assessment techniques and offering timely interventions, the nurse helps facilitate the patient's journey through the grieving process, promoting healthy coping mechanisms and ultimately assisting in achieving successful integration of their loss. Trustworthiness and a healthy attitude about grief are important qualities for a nurse, but without accurate assessment and intervention, the grieving process may not progress smoothly.

Correct Answer: B

Rationale: Adenomyosis is a condition characterized by the presence of endometrial tissue within the myometrium (muscle wall) of the uterus. It can present with symptoms such as cyclic pelvic pain, dysmenorrhea (painful periods), and infertility. On pelvic examination, the uterus may be retroverted (tilted backward) and enlarged due to the presence of adenomyotic nodules within the uterine muscle. Adenomyosis can also cause heavy menstrual bleeding (menorrhagia). Endometriosis, on the other hand, involves the presence of endometrial tissue outside the uterus and can cause similar symptoms but is less likely to result in uterine enlargement or retroversion. Leiomyomas (uterine fibroids) are benign tumors of the uterine muscle and can also cause pelvic pain and abnormal uterine enlargement but are less likely to be associated with dysmenorrhea and infertility

Correct Answer: D

Rationale: It is important for the nurse to explore Ella's feelings further when she expresses thoughts of wishing to be dead and struggling with not having someone around. These statements indicate that Ella may be experiencing emotional distress or depression, which require immediate attention. By exploring Ella's feelings, the nurse can assess the severity of her emotional state, provide appropriate support, and potentially prevent any harm or self-harm. It is crucial to address and validate her emotions, as well as to initiate necessary interventions to ensure her safety and well-being.