Professional Nursing Concepts and Challenges Test Bank

Correct Answer: A

Rationale: The nurse would question the order for a D-dimer test in this case. A D-dimer test is a blood test used to help rule out or diagnose blood clots. However, in a child with a fractured femur complaining of sudden chest pain and difficulty breathing, the symptoms suggest the possibility of a pulmonary embolism (PE). In this scenario, a D-dimer test may not be necessary because the clinical presentation warrants more advanced imaging studies such as V/Q scans, CT pulmonary angiography, or MR pulmonary angiography to definitively diagnose or rule out a PE. Therefore, the focus should be on imaging studies rather than a D-dimer test in this situation.

Correct Answer: C

Rationale: Placental abruption is the separation of the placenta from the uterine wall before delivery. This condition is a significant risk factor for disseminated intravascular coagulation (DIC) because the sudden detachment can lead to massive internal bleeding. The release of large amounts of tissue factor from the placenta into the maternal circulation triggers widespread activation of the coagulation cascade, leading to the consumption of clotting factors and platelets. This uncontrolled activation of the clotting system can result in both excessive clot formation and bleeding, characteristic of DIC. Gestational diabetes, polyhydramnios, and placenta previa are not direct risk factors for DIC.

Correct Answer: B

Rationale: Tetralogy of Fallot (TOF) involves four cardiac defects, as described in option B: pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta. These four defects result in mixing of oxygen-poor and oxygen-rich blood in the heart, leading to decreased oxygen levels in the blood that is pumped to the body. This characteristic results in cyanosis (blue discoloration of the skin). Providing accurate information about the specific defects involved in TOF helps parents understand the complexity and potential complications associated with their child's condition. This knowledge can aid in their ability to recognize symptoms and seek timely medical intervention when needed.

Correct Answer: A

Rationale: In a patient with an acute attack of gout, the nurse should expect the uric acid level to be increased. Gout occurs due to the buildup of uric acid crystals in the joints, leading to inflammation and pain. Monitoring the uric acid level is important in diagnosing and managing gout, as elevated levels indicate an increased risk of crystal formation and gout attacks. Therefore, an increased uric acid level is a key laboratory finding in patients experiencing gout flares.

Correct Answer: D

Rationale: Passive range-of-motion exercises are beneficial in maintaining joint flexibility in clients with stroke. These exercises involve moving the client's limbs through a full range of motion, which helps prevent joint contractures and stiffness. Joint flexibility is crucial for maintaining mobility and preventing secondary complications such as pressure ulcers. While passive range-of-motion exercises may indirectly impact muscle strength, cardiorespiratory function, and endurance, the primary rationale for this intervention is to maintain joint flexibility.