Adult Health Med Surg Nursing Test Banks

Correct Answer: D

Rationale: The assessment finding that is indicative of the diagnosis of hypertension is consistent evaluation of blood pressure. Hypertension is diagnosed based on repeated measurements of elevated blood pressure. Consistently high blood pressure readings, usually defined as systolic blood pressure consistently at or above 140 mmHg and diastolic blood pressure consistently at or above 90 mmHg, are a key factor in diagnosing hypertension. Family history of high blood pressure (Choice A), elevation of blood cholesterol level (Choice B), and a stressful work environment (Choice C) may be risk factors for hypertension but are not diagnostic criteria. In order to diagnose hypertension, healthcare providers rely on consistent measurement and evaluation of blood pressure over time.

Correct Answer: B

Rationale: As an epidemiology nurse, Nurse Rona's primary function and responsibility is to implement public health surveillance. Epidemiology nurses play a crucial role in monitoring and controlling the spread of diseases within communities. This involves conducting surveillance activities to identify patterns of disease occurrence, investigating outbreaks, collecting and analyzing data, and collaborating with various stakeholders to develop strategies for disease prevention and control. While providing nursing care to sick residents is important, the primary focus of an epidemiology nurse is on population-based health issues rather than individual patient care. Additionally, while Nurse Rona may assist epidemiologists in making reports and follow up cases and contacts, her main role is to implement public health surveillance to protect and promote the health of the community as a whole.

Correct Answer: D

Rationale: Record keeping involves several key steps such as structuring, securing, and storing information. However, easy disposal is not a step in record keeping. In fact, it is important to carefully consider the disposal of records in a secure and responsible manner to protect sensitive information and comply with relevant regulations. Proper disposal methods should be followed to ensure that records are not accessible to unauthorized individuals and that any sensitive information is properly destroyed to prevent misuse or breaches of privacy. Therefore, easy disposal is not a recommended practice in effective record keeping.

Correct Answer: A

Rationale: Nurse Nilda likely opted to review Erikson's psychosocial theory because completion of each developmental task in the theory results in a sense of competence and contributes to the development of a healthy personality. Erikson's theory outlines different stages of psychosocial development that individuals go through, with each stage presenting a specific conflict or challenge to be resolved. Successfully navigating and resolving these challenges at each stage leads to the development of essential strengths and virtues. For example, in Erikson's stage of industry versus inferiority (ages 6 to 11 years), successfully completing tasks related to school, sports, and social interactions can lead to a sense of competence and accomplishment. Conversely, failure to master these tasks can lead to feelings of inadequacy and inferiority. By understanding and applying Erikson's theory, Nurse Nilda can better support individuals in their development and help promote positive outcomes.

Correct Answer: C

Rationale: Preoperative nursing intervention that is essential for preparing a patient with a history of coronary artery disease for coronary artery bypass graft (CABG) surgery is assisting the patient with deep breathing and coughing exercises. These exercises are crucial to prevent postoperative complications such as atelectasis and pneumonia, which are common risks after surgery. Deep breathing exercises help to expand the lungs and improve ventilation, while coughing exercises help to clear secretions and prevent respiratory complications. By assisting the patient with these exercises preoperatively, the nurse can help optimize the patient's respiratory function and decrease the risk of complications during and after surgery. Administering aspirin, providing education about pain management, and obtaining informed consent are also important aspects of preoperative care, but assisting with deep breathing and coughing exercises is particularly essential for patients undergoing CABG surgery due to the increased risk of respiratory complications in this population.