Fundamental Concepts and Skills for Nursing Test Questions

Correct Answer: A

Rationale: A. Decreased muscle mass: As individuals age, there is a natural decline in muscle mass known as sarcopenia. This can lead to overall decreased muscle strength and functional ability.

Correct Answer: B

Rationale: - Elevating the client's knees on the bed or with a pillow can help improve venous return and promote circulation, ultimately enhancing peripheral tissue perfusion in a client with DIC.

Correct Answer: D

Rationale: Early preeclampsia is a condition characterized by high blood pressure and signs of damage to another organ system, commonly the liver and kidneys. Severe epigastric pain is a common symptom of this organ involvement. It is caused by liver distention due to the breakdown of red blood cells and platelets, which can lead to a condition known as HELLP syndrome. This manifestation is a significant indicator of early preeclampsia and requires prompt evaluation and intervention to prevent complications for both the mother and the baby. While the other options may be present in preeclampsia, severe epigastric pain is a more specific and concerning symptom requiring immediate attention.

Correct Answer: B

Rationale: Keeping the extremities warm (Choice B) is the appropriate nursing intervention for a client with peripheral vascular disease (PVD) experiencing pain. Maintaining warmth helps promote vasodilation and improve blood flow to the affected areas, reducing pain and discomfort. Cold temperatures can exacerbate vasoconstriction and worsen symptoms in individuals with PVD. Elevating the legs in bed (Choice A) may be beneficial in some cases to improve circulation, but in the context of pain management for PVD, keeping the extremities warm is more pertinent. Encouraging ambulation (Choice C) can also help improve circulation, but it may not be suitable during episodes of pain. Applying cool compresses (Choice D) is contraindicated for PVD-related pain as it can further exacerbate vasoconstriction and discomfort.

Correct Answer: B

Rationale: The patient's symptoms are indicative of kidney stones causing obstruction and possibly renal colic. The sudden onset of severe crampy pain on the left side radiating into the groin, along with nausea, vomiting clear fluid, and passing pink urine (hematuria) are classic signs of kidney stones. Given the severity of the symptoms and the potential for complications, it is crucial to notify the physician immediately for further evaluation and management. Straining all urine, administering analgesics, and obtaining a bladder scan may be necessary interventions but should be done after informing the physician and following their recommendations.