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: Hypoglycemia. At 4:30 p.m., after taking the morning insulin, the client's blood sugar may have dropped too low, leading to symptoms like headache, sweating, tremor, pallor, and nervousness. Regular insulin and NPH insulin peak at different times, causing a potential mismatch in insulin action, leading to hypoglycemia. Hyperglycemia (A) would present with different symptoms like increased thirst and urination. Hyperuricemia (B) is an excess of uric acid in the blood and does not typically present with these symptoms. Hypochondria (D) is a psychological condition and not related to the client's physical symptoms.

Correct Answer: A

Rationale: The correct answer is A because it includes essential nursing interventions for a patient with head injuries like J.E. Skin care and position changes every 2 hours help prevent pressure ulcers. Maintaining alignment of extremities prevents contractures. Respiratory exercises aid in lung function. Option B lacks the crucial aspect of maintaining extremity alignment. Option C includes teaching the use of an overhead trapeze, which may not be appropriate for J.E. Option D lacks the instruction to maintain extremity alignment, which is crucial for preventing contractures in patients with head injuries.

Correct Answer: A

Rationale: Correct Answer: A (Independent intervention) Rationale: 1. Independent interventions are actions that nurses can initiate without a doctor's order. 2. Teaching a client how to administer insulin falls under the scope of nursing practice. 3. Nurses have the knowledge and authority to educate clients on self-care management. 4. This intervention does not require collaboration with other healthcare providers. Summary: B: Dependent interventions require a doctor's order. C: Interdependent interventions involve collaboration with other healthcare providers. D: Collaborative interventions involve working with other healthcare professionals.

Correct Answer: B

Rationale: Rationale: 1. Discharge planning should start at admission to ensure comprehensive preparation. 2. Early planning allows for assessment of needs and coordination of resources. 3. It promotes continuity of care and reduces risks of readmission. 4. Options A, C, and D are incorrect as they miss the opportunity for proactive planning.