Nursing Process 1 Test Questions

Correct Answer: A

Rationale: The correct answer is A: Norepinephrine. Norepinephrine is the primary neurotransmitter that mediates the sympathetic response. It is released by sympathetic nerve endings and acts on adrenergic receptors in various target organs to initiate the "fight or flight" response. Prostaglandin, acetylcholine, and serotonin do not directly mediate the sympathetic response and are involved in different physiological processes.

Correct Answer: C

Rationale: The correct answer is C: Non-mobile mass with irregular edges delineated. This finding strongly suggests cancer as non-mobile masses with irregular edges are characteristic of malignant tumors. Cancerous lumps tend to be fixed in place due to involvement of surrounding tissues. Irregular edges indicate potential invasive growth. Choices A and B describe characteristics more commonly associated with benign masses. Eversion of the nipple is concerning for cancer but not specific enough to strongly suggest malignancy. Choice D indicates absence of lymph node involvement, which is not directly related to the characteristics of the breast lump.

Correct Answer: B

Rationale: The correct answer is B: Purplish discoloration of hands and feet. Hand-foot syndrome in sickle cell anemia is characterized by pain, swelling, and purplish discoloration of the hands and feet due to vaso-occlusive crisis. Unequal growth of fingers and toes (A), webbing between fingers and toes (C), and deformities of wrists and ankles (D) are not typical findings associated with hand-foot syndrome in sickle cell anemia.

Correct Answer: D

Rationale: The correct answer is D: To determine clients response to therapy. Evaluating BUN, creatinine, and serum electrolyte levels in a client being treated for acute pyelonephritis helps the nurse assess the effectiveness of the therapy. Changes in these levels indicate how well the kidneys are functioning and how the client is responding to treatment. Monitoring these parameters allows for adjustments in therapy if needed. Incorrect choices: A: To determine the severity of the disorder - While these tests can provide information about the severity of kidney dysfunction, the primary focus is on monitoring the response to therapy. B: To identify signs of fluid retention - While BUN and creatinine levels can indirectly indicate fluid status, the main purpose of evaluating these tests is to assess therapy response. C: To determine the location of discomfort - These tests do not provide information about the location of discomfort but rather focus on kidney function and response to treatment.

Correct Answer: D

Rationale: Step-by-step rationale: 1. A balanced and varied diet provides essential nutrients for immune function. 2. Including a wide range of foods ensures intake of vitamins, minerals, and antioxidants crucial for immune health. 3. Avoiding extremes like excessive immune-enhancing formulas or eliminating polyunsaturated fatty acids maintains balance. 4. Essential fatty acids and omega-3 fatty acids are beneficial but should be part of a well-rounded diet. 5. For clients with immune-mediated disorders, individualized dietary advice may be necessary. Summary: - A: Immune-enhancing formulas may not be necessary and could disrupt balance. - B: Avoiding all polyunsaturated fatty acids is not advisable as some are essential for health. - C: Increasing essential fatty acids is beneficial but should be part of a balanced diet.