Foundations and Adult Health Nursing Study Guide Answers

Correct Answer: B

Rationale: Heart failure is a condition in which the heart is unable to pump enough blood to meet the body's need for oxygen and nutrients. Ineffective tissue perfusion is a relevant nursing diagnosis for a client with heart failure because the heart's inability to effectively pump blood can lead to poor perfusion of tissues and organs, resulting in inadequate oxygen and nutrient delivery to cells. This can lead to symptoms such as fatigue, dyspnea, and edema, which are common in individuals with heart failure. By addressing ineffective tissue perfusion, nurses can focus on interventions to improve cardiac output and optimize tissue perfusion, ultimately improving the client's overall condition.

Correct Answer: B

Rationale: Streptococcus pneumoniae is the most common causative organism of bacterial pneumonia in adults. It is responsible for the majority of community-acquired pneumonia cases. Streptococcus pneumoniae is a gram-positive bacteria and is known to cause typical pneumonia characterized by sudden onset of high fever, productive cough with blood-tinged or rust-colored sputum, chest pain, and consolidation on chest imaging. Other organisms like Legionella pneumophila (choice A), Mycoplasma pneumoniae (choice C), and Haemophilus influenzae (choice D) can also cause pneumonia, but Streptococcus pneumoniae is the most likely culprit based on the patient's test results.

Correct Answer: A

Rationale: The correct practice in this situation would be to have a dedicated fire extinguisher in every strategic location throughout the hospital. Having fire extinguishers readily available in key areas ensures that they can be accessed quickly in case of a fire emergency. Placing one fire extinguisher between two units may not be sufficient as it may not be easily accessible in the event of a fire. Fire extinguishers should not be replaced with fire sensors as these serve different functions. Additionally, borrowing fire extinguishers may not be a safe or reliable practice, as they should be properly maintained and placed according to safety standards. Therefore, having dedicated fire extinguishers in every strategic location is the best practice to ensure the safety and well-being of individuals in the hospital.

Correct Answer: A

Rationale: The primary indicator that Nurse Mary observes FIDELITY in the practice of her profession is that she faithfully promotes health and prevents disease. Fidelity in nursing practice refers to being faithful, loyal, and committed to providing the best care and services to patients. By faithfully promoting health and preventing disease, Nurse Mary demonstrates her dedication to her profession, her patients, and the community she serves. This commitment includes following evidence-based practices, upholding ethical standards, being honest and trustworthy, and ensuring the well-being of those under her care. Ultimately, fidelity in nursing practice builds trust and confidence among patients, families, and colleagues, leading to better health outcomes and a stronger healthcare system.

Correct Answer: B

Rationale: The most appropriate action in this situation is to perform abdominal thrusts, also known as the Heimlich maneuver. This technique is used to clear a blocked airway caused by a choking obstruction. Encouraging continued coughing may not be effective if the person is unable to dislodge the obstruction on their own. Delivering back blows can sometimes be effective, but abdominal thrusts are more commonly recommended in cases of choking in adults. Administering rescue breaths is not recommended if the person is conscious and able to cough, as it may worsen the situation by pushing the obstruction further down. By quickly performing abdominal thrusts, you can help dislodge the obstruction and potentially save the person's life.