Nursing Process Questions and Answers PDF

Correct Answer: B

Rationale: The correct answer is B because the inability to move the affected leg post lumbar microdiskectomy could indicate a serious complication like nerve damage or blood clot. This would require immediate medical attention to prevent further complications. Incisional pain (A) is common and can be managed with pain medication. A two-inch area of bleeding on the dressing (C) is concerning but can be managed with proper wound care unless it is excessive. Muscle spasm (D) is also common postoperatively and can be managed with medications or physical therapy.

Correct Answer: B

Rationale: The correct answer is B: 45-year old woman who has never been pregnant. This client has the highest risk of ovarian cancer due to nulliparity, which is a known risk factor. Women who have never been pregnant have a higher risk of developing ovarian cancer compared to those who have had children. Other choices are incorrect because contraceptives actually reduce the risk of ovarian cancer, having children can slightly decrease the risk, and having a child at a young age does not increase the risk significantly.

Correct Answer: C

Rationale: The correct answer is C because a lack of response to intradermal anergy testing suggests an inability to mount a normal delayed-type hypersensitivity response, indicating immunodeficiency. This could be due to conditions such as HIV, which impairs cell-mediated immunity. Choice A is incorrect because absence of reaction does not necessarily indicate lack of previous exposure to antigens. Choice B is incorrect as the absence of response doesn't confirm the presence of antibodies. Choice D is incorrect because anergy testing is not used to assess allergy, but rather to evaluate cell-mediated immunity.

Correct Answer: A

Rationale: The correct answer is A: Decreased serum sodium level. In SIADH, there is an excessive release of ADH, causing water retention and dilution of sodium in the blood. This leads to hyponatremia. B: Increased blood urea nitrogen and C: Decreased serum creatinine level are not typically associated with SIADH. D: Increased hematocrit is not a typical finding in SIADH, as it is more related to dehydration. Therefore, the most anticipated laboratory test result in a client with SIADH is a decreased serum sodium level due to dilutional hyponatremia.

Correct Answer: A

Rationale: The modified Trendelenburg position involves placing the client with their legs elevated higher than their head. This position promotes venous return to the heart, increasing preload and cardiac output, thereby leading to an increase in blood pressure. Elevating the legs helps to reduce peripheral edema and improve circulation. Therefore, the correct answer is A. Choice B is incorrect because the Trendelenburg position does not directly affect the respiratory rate. Choice C is incorrect as the position is not intended to increase heart rate but rather improve venous return. Choice D is also incorrect as the primary goal of the Trendelenburg position is not to decrease blood loss, although it may help in some cases by improving circulation.