test bank foundations of nursing

Correct Answer: B

Rationale: The correct answer is B: Mitral valve prolapse. This condition is usually benign during pregnancy because the heart's workload increases, and the mitral valve is a one-way valve that prevents blood from flowing back into the left atrium. Mitral valve prolapse typically does not significantly affect the heart's ability to pump blood efficiently during pregnancy. Rationale: 1. Cardiomyopathy (A) can worsen during pregnancy, leading to complications for both the mother and the fetus. 2. Rheumatic heart disease (C) can cause valve damage, increasing the risk of complications during pregnancy. 3. Congenital heart disease (D) varies in severity and can pose risks during pregnancy, depending on the specific condition. Summary: Mitral valve prolapse is the correct answer as it is less likely to cause significant issues during pregnancy compared to the other options provided.

Correct Answer: B

Rationale: The correct answer is B: Mitral valve prolapse. This condition is usually benign during pregnancy because the heart's workload increases, and the mitral valve is a one-way valve that prevents blood from flowing back into the left atrium. Mitral valve prolapse typically does not significantly affect the heart's ability to pump blood efficiently during pregnancy. Rationale: 1. Cardiomyopathy (A) can worsen during pregnancy, leading to complications for both the mother and the fetus. 2. Rheumatic heart disease (C) can cause valve damage, increasing the risk of complications during pregnancy. 3. Congenital heart disease (D) varies in severity and can pose risks during pregnancy, depending on the specific condition. Summary: Mitral valve prolapse is the correct answer as it is less likely to cause significant issues during pregnancy compared to the other options provided.

Correct Answer: C

Rationale: The correct answer is C: Normal deep tendon reflexes. This indicates a therapeutic level of magnesium sulfate as it shows that the medication is effectively preventing hyperreflexia, a common sign of magnesium toxicity. Drowsiness (choice A) can indicate toxicity. Urinary output of 20 mL/hour (choice B) is not specific to magnesium sulfate levels. Respiratory rate of 10 to 12 breaths per minute (choice D) is indicative of respiratory depression, a sign of magnesium toxicity. Thus, choice C is the best assessment to indicate a therapeutic level of medication in a patient with preeclampsia taking magnesium sulfate.

Correct Answer: A

Rationale: The correct answer is A: Tumor lysis syndrome (TLS). In this scenario, the oncology patient has completed treatment for non-Hodgkin lymphoma. TLS is a potential complication post-treatment due to the rapid breakdown of cancer cells, leading to release of intracellular contents like potassium, phosphorus, and uric acid into the bloodstream. This can result in electrolyte imbalances, renal failure, and cardiac arrhythmias. The nurse should assess for signs such as hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid levels. Monitoring renal function and fluid status is crucial. Summary of other choices: B: Syndrome of inappropriate ADH (SIADH) is characterized by excessive release of antidiuretic hormone leading to water retention and dilutional hyponatremia. Not typically associated with post-treatment complications in oncology patients. C: Disseminated intravascular coagulation (DIC)

Correct Answer: A

Rationale: The correct answer is A: Perianal region and oral mucosa. In patients with AIDS, these areas are more prone to opportunistic infections due to decreased immune function. The perianal region can be affected by conditions like anal warts or herpes, while the oral mucosa can develop oral thrush or other oral infections. By prioritizing assessment of these areas, the nurse can promptly identify any potential issues and initiate appropriate interventions. Choice B: Sacral region and lower abdomen are not typically high-risk areas for skin integrity issues in AIDS patients. Choice C: Scalp and skin over the scapulae are not commonly affected by opportunistic infections related to AIDS. Choice D: Axillae and upper thorax are not as commonly affected as the perianal region and oral mucosa in AIDS patients.