Adult Health Nursing First Chapter Quizlet

Correct Answer: D

Rationale: The nurse who uses appropriate therapeutic listening skills will display the best behavior by absorbing both the content and the feeling which the patient is conveying. In the given scenario, Belle is experiencing a range of symptoms due to her mental health issues, trauma, and past experiences. By actively listening and absorbing both the content (symptoms, concerns) and the feelings (depressed mood, worry, irritability) which Belle is conveying, the nurse can demonstrate empathy, understanding, and validation of Belle's experiences. This type of therapeutic listening helps to build trust, rapport, and a supportive therapeutic relationship between the nurse and the patient, which is crucial for effective communication, assessment, and treatment in mental health care settings.

Correct Answer: D

Rationale: The presentation described in the question – sudden-onset unilateral headache along with ipsilateral ptosis, miosis, and anhidrosis – is characteristic of Horner syndrome. Horner syndrome is caused by disruption of the sympathetic nerve pathway and can occur in trigeminal neuralgia. Trigeminal neuralgia is a painful condition affecting the trigeminal nerve commonly characterized by sudden and severe facial pain that can be triggered by various stimuli. The involvement of the sympathetic pathway in trigeminal neuralgia can lead to Horner syndrome symptoms such as ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face. Cluster headaches usually involve severe unilateral pain around the eye, but they do not typically present with Horner syndrome symptoms. Migraine and tension-type headaches also do not typically present with Horner syndrome symptoms.

Correct Answer: C

Rationale: Assessing the patient for respiratory distress is the important nursing intervention that must be done in this situation. The scenario provided indicates that the patient with chronic obstructive pulmonary disease (COPD) is experiencing increased work of breathing, which puts them at risk for respiratory distress. It is crucial for the nurse to monitor the patient's respiratory status closely, including assessing their oxygen saturations, respiratory rate, and effort, to identify any signs of respiratory distress early and intervene promptly. This proactive assessment can help prevent further deterioration of the patient's condition and ensure appropriate nursing interventions are implemented promptly.

Correct Answer: A

Rationale: The most important intervention for managing ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in a patient undergoing mechanical ventilation in the ICU is to start appropriate antimicrobial therapy targeting MRSA. Vancomycin or linezolid are commonly used antibiotics for MRSA infections. These medications are effective against MRSA and can help in treating the infection and preventing further complications. It is crucial to initiate antimicrobial therapy promptly once the diagnosis of VAP caused by MRSA is suspected or confirmed to improve patient outcomes. Other interventions such as bronchoalveolar lavage for diagnostic purposes, contact precautions, or antifungal therapy may be relevant but the priority is to start effective antibiotic therapy to target the specific pathogen causing the infection.

Correct Answer: A

Rationale: In a pregnant woman presenting with severe abdominal pain, syncope, signs of hypovolemic shock, and gestational age of 6 weeks, the most likely cause is an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, commonly in the fallopian tube. As the pregnancy grows and the tube stretches, it can lead to rupture, causing severe abdominal pain, internal bleeding, and signs of shock. This is a life-threatening emergency that requires prompt diagnosis and management. It is important to consider ectopic pregnancy in any pregnant woman presenting with abdominal pain and signs of shock, especially in the first trimester.